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NM III > Mod-Severe TBI > Flashcards

Mod-Severe TBI Flashcards

1
Q

Prognosis

A

Highly variable

Depends on
- severity of injury
- age
- CT abnormalities
- concomitant injuries
- length of post-traumatic amnesia (PTA)

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2
Q

Post-traumatic amnesia (PTA)

A

Inability to create new memories

Mild: <24 hours
Mod: 1-7 days
Severe: >7 days

> 2 weeks, prognosis is less optimistic

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3
Q

Glasgow coma scale

A

Measures severity

3 categories
- verbal response
- eye opening
- motor response

Mild: 13-15
Moderate: 9-12
Severe: 3-8

See chart

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4
Q

Primary brain injuries

A

Concussion
Diffuse axonal injury
Anoxic/hypoxic brain injury
Contusion
Laceration
Hemorrhage

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5
Q

Secondary brain injuries

A

Hypotension
Hypoxia
Increased ICP
Cerebral edema
Vasospasm
Failure of autoregulation
Excitotoxicity
Production of free radicals

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6
Q

Diffuse brain injuries

A

Concussion
Diffuse axonal injury (DAI)
Anoxic/hypoxic brain injury
Metabolically active areas (hippocampus, purkinje cells, basal ganglia)

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7
Q

Focal brain injuries

A

Contusion
Laceration
Hemorrhage

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8
Q

Diffuse axonal injury (DAI)

A

Widespread stretching of axons caused by rotation of the brain

Involves white matter, deeper structures if more severe

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9
Q

Anoxic/hypoxic injury

A

Oxygenation status
MOI: asphyxiation, drowning, anaphylaxis

Parietal/occipital cortices, hippocampus, cerebellum, basal ganglia

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10
Q

Poor prognostic factors

A

Hypotension
Hypoxia
Apnea
Cyanosis
Increased intracranial pressure

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11
Q

Intracranial pressure

A

Increased volume in one area decreases volume in another

Increased pressure can cause midline shift of herniation

Management
- surgical decompression
- elevate HOB
- cooling
- diuretics

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12
Q

How to limit secondary injury

A

Decrease brain metabolism/energy needs
- paralytics decrease stimulation
- barbituates decrease metabolic rate
- hypothermia decreases metabolic rate

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13
Q

Possible consequences of TBI

A

Focal deficits based on area of injury

Cranial nerve damage

Cognitive and neurobehavioral issues

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14
Q

Occipital contusions

A

visual processing difficulties or cortical blindness

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15
Q

Motor cortex injury

A

contralateral paresis or paralysis

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16
Q

Brainstem injury

A

disruption in cardiac and respiratory function

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17
Q

Possible complications of TBI

A

heterotopic ossifications
Intracranial infection
Seizures

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18
Q

post ictal

A

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

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19
Q

status epilepticus (SE)

A

A seizure that lasts longer than 5 minutes, or having more than 1 seizure within a 5 minutes period, without returning to a normal level of consciousness between episodes

Medical emergency, can be fatal

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20
Q

Potential causes of acute seizures

A

Metabolic
Drug induced
Illness
Neurologic

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21
Q

Epilepsy prognosis

A

Increased mortality
Increased risk of death by asphyxia
Increased risk of drowning
Increased risk of depression/suicide

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22
Q

Focal onset seizure

A

Abnormal electrical discharge in specific part of brain (focused)

Awareness is retained during, no LOC

Jerking, paresthesia, or hallucinations

Auras

23
Q

Focal dyscognitive seizure

A

Awareness is altered or LOC

Temporal or occipital lobe

Person appears confused

45-90 seconds

24
Q

Focal absence seizure

A

Sudden cessation of ongoing conscious activity

Minor convulsive m. activity

Staring/eye blinking

Common in childrren

25
Q

Generalized onset

A

Abnormal electrical activity wide-spread throughout brain

26
Q

Generalized myoclonic seizure

A

Quick muscular jerky movement of body part or entire body

Potential LOC

Duration of seconds, may cluster

27
Q

Generalized B tonic-clonic seizure

A

B convulsive seizures w/ tonic and/or clonic manifestations

LOC, rigidity (tonic), jerking (clonic)

Post: headache, soreness, mental dulling

Complications: fractures, shoulder dislocation, aspiration, death

28
Q

Generalized atonic seizure

A

Brief LOC and loss of postural tone

“drop attacks”

Common in children

29
Q

Gabapentin

A

Seizure med

anticonvulsant

tonic-clonic

30
Q

Lamotrigine

A

Seizure med

acts on sodium channels

31
Q

Topiramate

A

seizure

blocking sodium channels

32
Q

Tiagabine

A

seizure

block reuptake of GABA

33
Q

Seizure safety protocol

A

Call for help or code

Secure patient
- ease patient to ground or chair
- clear space around, pillow behind head
- careful logroll to clear secretions if necessary

Do not put anything in pt. mouth or hold patient down (risk of fracture)

34
Q

ED visit post-seizure

A

May not be necessary if
- return to cognitive baseline
- no physical injuries
- fall w/ seizure was witnessed
- no neck pain, concussion, vomiting, numbness, weakness

35
Q

Seizures and exercise

A
  • Hx of seizures
  • medications
  • patient education for medication consistency
  • seizure triggers
  • type/frequency
  • refer for depression

Activity restriction for 2-3 months after new seizure diagnosis

Ask neurologist if vigorous activity is safe

36
Q

Side effects of seizure medication

A

slowed cognition
altered reaction time
nystagmus
ataxia
dysarthria
lethargy
nausea
irritability
skin rash

37
Q

Coma recovery scale revised (CRS-R)

A

Assists w/ diagnosis, prognosis, treatment planning

Coma vs vegetative state vs minimally conscious

monitors changes over time

38
Q

Rancho los amigos (RLA)

A

cognitive-behavioral stages of recovery from TBI

39
Q

CRS-R: Coma

A

RLA I: no response

complete loss of arousal

no sleep/wake cycle

40
Q

CRS-R: vegetative state/unresponsiveness wakefulness syndrome

A

RLA II: generalized response

return of sleep/wake cycle

no behaviors indicating awareness of self or environment

41
Q

CRS-R: minimally conscious state

A

RLA III: localized response

behavior indicates awareness of self and/or environment

42
Q

CRS-R: emerging consciousness

A

RLA IV: confused-agitated

43
Q

CRS-R: post traumatic confusional

A

RLA V: confused, inappropriate

44
Q

CRS-R: post traumatic cognitively impaired

A

RLA VI: confused, appropriate

emerged from PTA

45
Q

RLA level II-III goal

A

main goal - stimulation

46
Q

RLA level IV-V goal

A

allowing

encouraging patient to be a more active participant in therapy

47
Q

RLA level VI-X goal

A

initiation, more structure, new learning, gaining independence

return to optimal level of function and participation

48
Q

retrograde amnesia

A

partial or total loss of ability to recall event that have occurred during the time immediately before the brain injury

49
Q

anterograde memory

A

ability to form more complete new memories, complicated by decreased attention and perception

50
Q

post traumatic amnesia (PTA)

A

the time between the injury and the point at which functional memory returns

51
Q

CRS-R: consciousness has emerged; RLA VII

A

automatic, appropriate

min A needed for daily living skills

ability to functionally communicate or use objects

52
Q

CRS-S: consciousness has emerged; RLA VIII

A

purposeful, appropriate

SBA needed for cog-behavior

53
Q

CRS-R: consciousness has emerged; RLA IX/X

A

purposeful, appropriate

SBA upon request for cog-behavior; modified independent

NM III (4 decks)

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