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Neuro III > Mod/Severe TBI > Flashcards

Mod/Severe TBI Flashcards

1
Q

Traumatic Brain Injury

A

injury to the brain due to the application of an external physical force or rapid acceleration/deceleration forces that results in impairments in cognitive, emotional, behavioral and physical functioning

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2
Q

What age range is the highest risk factor for a TBI?

A

18-25 years

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3
Q

What is the single larges indirect cause?

A

Alcohol abuse

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4
Q

GCS
13-15 - ?
9-12- ?
3-8- ?

A

13-15= mild
9-12= moderate
3-8= severe

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5
Q

Post Traumatic Amnesia

A

inability to create new memories

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6
Q

Post Traumatic Amnesia
Lasting <24 hours

A

Mild

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7
Q

Post Traumatic Amnesia
Lasting 1-7 days

A

moderate

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8
Q

Post Traumatic Amnesia
Lasting >7 days

A

severe

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9
Q

> 2 weeks PTA prognosis is ___

A

less optimistic

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10
Q

If a patient has persistent PTA what is that termed

A

amnestic syndrome

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11
Q

Survivors of _____ traumatic brain injury constitute a small percentage of the total group of TBI survivors, but they account for the majority of those who receive acute TBI rehab

A

severe

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12
Q

Vast majority of TBIs are mild 80%
whats the survival percentage?

A

100%

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13
Q

about 10 percent of TBIs are moderate what is the survival percentage

A

93%

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14
Q

About 10 percent of TBIs are severe
what is the survival percentage?

A

43%

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15
Q

Prognosis for TBI is highly variable and depends on several factors what are some of the most important (5)

A
  1. initial severity of injury
  2. age - very young and very old poor prognosis
  3. CT abnormalities
  4. Concomitant injuries- SCI with TBI
  5. Length of post traumatic amnesia
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16
Q

Types of primary brain injuries (6)

A
  1. concussion
  2. Diffuse axonal injury- stretching shearing
  3. anoxic/hypoxic brain injury- lack of blood flow to brain
  4. Contusion- brain bruise
  5. Laceration
  6. Hemorrhage- internal bleed
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17
Q

Types of secondary brain injuries (8)

A
  1. Increased intra cranial pressure
  2. Cerebral edema
  3. Hypotension
  4. Vasospasm
  5. Failure of auto-regulation
  6. Hypoxia
  7. Excitoxicity
  8. productioN of free radicals
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18
Q

What is normal intracranial pressure

A

0-15

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19
Q

Two types of brain injuries?

A

Diffuse and Focal

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20
Q

What are the types of diffuse brain injuries?

A
  1. Concussion
  2. Diffuse Axonal Injury
  3. Anoxic/hypoxic brain Injury
  4. metabolically active areas
    -hippocampus, cerebellar, basal ganglia
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21
Q

What are the types of focal brain injures?

A
  1. Contusion
  2. Laceration
  3. Hemorrhage
    -epidural hematoma
    -subdural hematoma
    -subarachnoid hemorrhage
    -intracerebral hematoma
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22
Q

What does closed brain injury mean?

A

closed means the skull is intact

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23
Q

Coup-contre coup is an example of what type of brain injurY

A

Closed

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24
Q

What does an open brain injury mean?

A

open injury means the skull is fractured or broken
this could be due to impact, explosion, projectiles and gunshot wounds

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25
Q

Which is more sensitive MRI or CT in terms of TBI

A

MRI is more sensitive
CT can show acute, blood, bone, edema- shows active bleed and cracked skull

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26
Q

epidural Hemorrhage/hematoma

location
type of bleed
cause
treatment
subjective

A

epidural hemorrhage/hematoma

Location: between skull and dura
Arterial bleeding- fast
Cause: laceration of the middle meningeal artery from temporal fracture- blow to head
Treatment: surgery
subjective: headache im going to sleep it off
clear mentally before they rapidly become unclear
Ex: pt seems okay but after ski accident they dont wake up

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27
Q

Subdural Hemorrhage/hematoma
location
type of bleed
cause
treatment

A

Location: between the dura mater and brain surface
Bleed: venous slow bleed
Cause: can occur with minimal force in the elderly and chronic alcoholics
Treatment: may require surgical evacuation if causing mass effect or worsening symptoms

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28
Q

What is the main difference between epidural hematoma and a subdural hematoma

A

epidural- arterial blood fast

subdural- venous blood slow

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29
Q

Subarachnoid hemorrhage
location
type of bleed
cause
treatment

A

subarachnoid hemorrhage- only considered a stroke if it happens spontaneously

location: bleed directly in the brain parenchyma
Blood: arterial blood fast
Cause: gun shot wound, fall, due to a burst aneurysm

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30
Q

Contusion
location
cause

A

contusion: occurs from the brain impacting the skull
-brain moving over the sharp edge in the skull
often considered a brain bruise

Cortical areas overlying basal skull structures are particularly vulnerable

inferior frontal lobes, anterior and medial temporal lobes, ventral brainstem

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31
Q

Explain Diffuse Axonal Injury

A

widespread stretching of axons caused by rotation of the brain around its axis and the differential effect of rotational and acceleration/deceleration forces. may be better described as multifocal

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32
Q

Does a Diffuse Axonal injury involve white or gray matter

A

white matter throughout the brain, deeper structures such as corpus callosum and brainstem indicate higher severity

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33
Q

Explain anoxic or hypoxic injury

A

consider oxygenation status in the field
mechanism of trauma ie: asphyxiation, drowing, anaphylaxis

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34
Q

What are poor prognostic factors related to lab values

A

hypotension SBP <90 bpm
Hypoxia PaO2 <60 mm Hg apnea or cyanosis in field
Intracranial pressure
normal <15mmhg
if >20 mmHg mortality 50-60%

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35
Q

______volume in one area of the brain _______ volume in another area

A

increased volume in one area of the brain decreased volume in another area

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36
Q

When unable to auto-regulate pressure, ICP _____.

A

when unable to auto-regulate pressure ICP increases

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37
Q

What two pressures need to me monitored in a patient with a TBI

A

Intracranial pressure- 0-15 mmhg
Cerebral perfusion pressure- 60-100mmhg

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38
Q

What is Cerebral Perfusion pressure and how do you measure it

A

pressure at which the brain tissue is being perfused
MAP-ICP=CPP

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39
Q

intracranial pressure can cause ____ shift and herniation

A

midline shift

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40
Q

How can you measure intracranial pressure?

A

use of a monitoring device- a bolt monitor
surgery- decompression, debridement, bone flap

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41
Q

early management to decrease brain metabolism

A

paralytics
barbiturates
hypothermia

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42
Q

What do paralytics do in early management to decrease brain metabolism

A

act at neuromuscular junction decreasing stimulation
shut down body to shut down demand on the brain

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43
Q

What do barbiturates do in early management to decrease brain metabolism

A

decrease metabolic rate
undesirable side effects (sedate)

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44
Q

does hypothermia decrease or increase metabolic rate of the brain

A

decrease

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45
Q

Occipital contusions can impact what?

A

visual processing difficulties or cortical blindness

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46
Q

Motor cortex injury can impact what

A

contralateral paresis or paralysis

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47
Q

Brain stem injury can result in what

A

disruption in cardiac and respiratory function

48
Q

Cranial nerve damage
1. lack of smell
2. blindness
3. depth perception problems and diplopia
4. swallowing problems

A
  1. CN I olfactory
  2. CN II optic
  3. CN III, IV, VI oculomotor, trochlear, abducens
  4. IX hypoglossal
49
Q

Frontal lobe injury- neurobehavioral issues

A

may be due to whole brain trauma or injury to frontal lobe

50
Q

What medication can be taken to regulate mood

A

amantadine

51
Q

What medication can be taken to increase stimulate brain activity

A

ritalin
dopamine agonist
provigil

52
Q

What is heterotopic ossification and what are the risk factors

A

pain decreased ROM, edema
Risk factors: whole body trauma, immobility, spasticity, long bone fractures, prolonged coma

53
Q

What is the treatment for HO

A

NSAIDs, ROM

54
Q

What are two other complications to TBI?

A

intracranial infection- especially with open TBI

seizures- especially with open TBI and hemorrhagic injuries

55
Q

How are post traumatic seizures classified?
<24 hours from time of injury
1-7 days from time of injury
>7 days from time of injury

A

classified by the time since injury
1. immediate
2. early
3. late

56
Q

During the first 2 years after injury individuals are ___X greater risk of siezure

A

3x

57
Q

If epilepsy develops, medications are needed for ____

A

life

58
Q

____ is the #1 cause of death in children over 1 y.o.

A

trauma

59
Q

areas of brain do not function in _____, especially in young children

A

isolation

60
Q

_______: responsible for 56% of severe injuries in infants and 90% of severe injuries in 1-4 yrs old

A

abusive head trauma

61
Q

_____: responsible for 39% of injuries under 14 years old and leading cause of injury under 4 years old

A

falls

62
Q

______: responsible for 66% of injuries in adolescents and 20% in young children

A

MVC

63
Q

Explain shaken baby syndrome: non- accidental trauma

A

acute and chronic subdural hemorrhages
intraparenchymal injury
retinal hemorrhages
multiple fracture of ribs/long bones
various stages of healing

64
Q

children have _____ head with ___necks

A

larger heads with weaker necks

65
Q

there is less _____ and higher brain water in children

A

myelin

66
Q

_____ can go to deeper parts of the brain in children

A

forces can go to deeper parts of the brain

67
Q

Medical intervention in the PICU

A

neurobehavioral therapy
establish day- night cycle
sensory stimulation
maintain familiar routine, objects, surroundings

68
Q

What medications improve arousal

A

dopamine agonist
amantadine
provigil
ritalin

69
Q

What medications decrease agitation/sedation

A

benxodiazepine

70
Q

14-23% of pediatric TBI survivors have

A

Heterotopic ossification

71
Q

HO presents early with what signs in children

A

warmth, erythema, decreased ROM

72
Q

What happens in a child less than <7 years of age with diffuse brain injuries

A
  1. less physical development infrastructure for recovery to build upon
  2. injury alters subsequent development of the brain
  3. They are more likey to have cognitive and social difficulties long term
73
Q

Seizures

A

an episode of neurologic neurologic dysfunction caused by an abnormal imbalance of excitatory and inhibitory neurotransmitters neuronal activity that results in a sudden change in behavior, sensory perception or motor activity

74
Q

How long do seizures last?

A

finite and brief rarely last longer than 30-90sec

75
Q

Can seizures cause transient brain impairment or LOC

A

yes

76
Q

If the underlying cause for seizure is eliminated the seizure will stop true/false

A

true

77
Q

in _____ individuals seizures occur unpredictably at any time and without any relationship to activities

A

most

78
Q

in ____ individuals seizures are provoked by specific stimuli such as flashing lights or a flickering television

A

some

79
Q

What is Ictus or ictal

A

period in which the seizure occurs

80
Q

Post ictal

A

period after seizure ends but before patient has returned to his or her baseline mental status

81
Q

Status Epilepticus (SE) is common in people who have a known cause such as

A

tumor, CNS infection, drug abuse

82
Q

can status epilepticus be fatal

A

yes

83
Q

What are four potential causes of acute seizures?

A
  1. metabolic
  2. drug induced
  3. illness
  4. neurologic
84
Q

Epilepsy

A

refers to recurrent seizures from known or unknown causes

85
Q

Epilepsy affects how many americans?

A

3 million

86
Q

What are 4 common risk factors for seizures?

A
  1. developmental disability
  2. head trauma
  3. stroke hx
  4. family hx seizures
87
Q

Febrile convulsions are the most common seizure disorder during _____ and have excellent prognosis

A

Childhood

workup is still warranted because there is a possibility of an underlying acute infectious disease such as sepsis or bacterial meningitis

88
Q

What are 4 prenatal and perinatal factors?

A
  1. hypoxia-ischemia
  2. congenital infection
  3. inborn errors of metabolism
  4. prematurity
89
Q

What are 3 postnatal conditions?

A
  1. CNS infections
  2. head trauma
  3. Hypoxic-ischemic encephalopathy
90
Q

What is the greatest concern in instances when the individual has a seizure during eating

A

asphyxia

91
Q

What are the two types of seizures?

A

Focal onset
Generalized onset

92
Q

Explain Focal onset

A

abnormal electrical discharge clearly begins in one specific part of the brain

93
Q

Explain generalized onset

A

abnormal electrical activity is wide-spread throughout the brain very early in the seizure

94
Q

During focal seizures awareness can be retained if awareness is not retained it is called ____

A

focal dyscognitive seizure

95
Q

motor symptoms (jerking) or sensory symptoms (paresthesias or tingling) that spread to different parts of the body

A

focal seizure

96
Q

Psychotic responses to seizure activity include illusions hallucinations a sudden sense of fear is common

A

focal seizure

97
Q

person appears dazed and confused with random walking, mumbling, head turning or pulling at clothes
lasts 45- 90 sec and is followed by confusion and disorientation lasting several more minutes

A

focal seizure- focal dsycognitive seizure

98
Q

consist of the sudden cessation of ongoing conscious activity with only minor convulsive muscular activity or loss of postural control

A

absence seizure

99
Q

absence seizure typically occur in children and frequently disappear by adolescence

A

true

100
Q

sudden brief, single or repetitive muscle contractions involving one body part or the entire body

A

myoclonic- generalized seizure

101
Q

manifestations include a sudden LOC, generalized rigidity and rapid generalized jerking movement

with recovery individuals may c/o headache, muscle soreness, mental dulling, lack of energy or mood changes

A

bilateral convulsive seizure with tonic and/or clonic
generalized seizure

102
Q

a brief losses of consciousness and postural tone not associated with tonic muscular contractions

the seizures are often called drop attacks
they occur most often in children with diffuse encephalopathies and are characterized by sudden loss of muscle tone that may result in falls with injury

A

atonic seizures- generalized

103
Q

An anticonvulsant is used as an add-on drug for individuals with refractory complex partial and secondary generalized tonic-clonic seizures

A

gabapentin (neurontin)

104
Q

drug acts at voltage-sensitive sodium channels to stabilize neuronal membranes and inhibit neuronal release, particularly of glutamate

A

lamictal

105
Q

blocking voltage dependent sodium channels

A

topamax

106
Q

blocking reuptake of neuroinhibitory transmitter GABA into neuronal and glial cells

A

gabitril

107
Q

seizure med

A

keppra

108
Q

brain injury med

A

depakote

109
Q

what does a vagal nerve stimulator do?

A

can be provided through an implantable pulse generator
by stimulating the left vagal nucleus an inhibitory projection influences the entire cerebral cortex

vagal nerve stimulation has been reported to result in 50% reduction in seizure

110
Q

What do you do when someone is having a seizure?

A

call out help or push code button

secure the patient
help the patient be seated or catch the patient if you are physically able to and ease them to the ground

clear the space around them and place a pillow behind the head

attempt a careful log roll of the patient to one side to clear secretions or vomit

111
Q

What do you not do during a seizure

A

put anything in the patients mouth during a seizure this can cause broken teeth aspiration, injury

hold down the patient

112
Q

ED may not be necessary when?

A

if the patient has know epilepsy and they have quickly returned to their cognitive baseline

no physical injury was sustained that needs additional evaluation

the fall with seizure onset was witnessed
no neck pain, concussion, vomiting or new neurological deficits

113
Q

What does a PT need to know regarding exercise

A

hx of seizure diagnosis
medication
patient education
seizure triggers
type and frequency of seizures
refer if signs of depression are present

114
Q

for a new diagnosis of seizure what should the person do

A

activity restrictions for the first 2-3 months
recs for safe activity
medical treatment must be initiated and monitored

115
Q

side effects of seizure medication

A

slowed congition
altered reaction time
nystagmus
ataxia
dysarthria
nausea
irritability
skin rash

116
Q

Colorado a doctor is ____ required to report that a person has a seizure disorder to the DMV

A

not

Neuro III (23 decks)

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