Moderate/Severe TBI

Question 1

5 acquired TBI

Answer 1

Anoxic: occlusion of O2, 15 sec LOC

Hypoxic: not enough O2 saturation, suffocation

Open/closed head injury

Shaken baby

Non-traumatic (stroke)

Question 2

A TBI is a results of

Answer 2

Biochem, cellular and molecular events that evolve over time

Question 3

Primary damage of TBI (6)

Answer 3

-scalp laceration
-skull fx
-cerebral contusion
-cerebral laceration
-intracranial bleeding
-diffuse axonal injury

Question 4

4 secondary damage of TBI

Answer 4

Ischemia
Hypoxia
Cerebral swelling
Infection

Question 5

What is DAI? Causes?

Answer 5

Diffuse axonal injury = shearing
-most common type of primary lesion
-from accel/decel or rot injuries

Question 6

Grade 1 DAI

Answer 6

mild - microscopic change in white matter of cerebral cortex, corpus collosum, brain stem, and cerebellum

Question 7

Grade 2 DAI

Answer 7

Mod - lesions isolated to corpus collosum

Question 8

Grade 3 DAI

Answer 8

Severe - multiple and severe focal lesion on brain stem

Question 9

What is a dural hematoma

Answer 9

Skull fx tear meningeal artery vessels
-tears v superior sagittal sinus (where CSF leaks)

Question 10

What parts of the brain are involved with motor function (5)

Answer 10

Brain stem, midbrain, cerebellum, cortex, BG

Question 11

What are 3 functions of the prefrontal cortex

Answer 11

Working mem, self control, decision making

Question 12

How is amygdala involved with TBI

Answer 12

Increased emotional regulation and fear response

Question 13

How is hippocampus involved with TBI

Answer 13

Decreased memory and learning

Question 14

What part of the brain is involved with sleep, wake cycle/arousal

Answer 14

Mid brain

Question 15

What are 4 majorly motor outcomes of mod-severe TBI

Answer 15

-hemiparesis
-cerebellar ataxia
-synergistic movement
-contractures

Question 16

What are 3 systems of control regarding the reticular activation system

Answer 16

Waking
Sleeping
Fight or flight

Question 17

What part of the brain is involved with waking (think reticular activation system)

Answer 17

Thalamus

Question 18

What is the function of the reticular formation

Answer 18

Integration, relay and coordination

Question 19

What CN are associated with reticular formation

Answer 19

Trigeminal 5
facial 7
glossopharyngeal 9
vagus 10
Hypoglossal 12

Question 20

What part of the brain causes sleep dysfxn

Answer 20

Frontal temporal lobe

Question 21

What is decreased to cause sleep dysfxn

Answer 21

Melatonin

Question 22

What part of the brain assists with circadian rhythm

Answer 22

Hypothalamus

Question 23

What are the two main stages of TBI

Answer 23

Initial trauma and cellular response

Question 24

What is increased with exercise in TBI (4)

Answer 24

-brain derived neurotrophic factor and orexin
-long term potentiation (neuroplasticity)
-neuro genesis
-anti inflam cytokines

Question 25

What does exercise in TBI help decrease

Answer 25

Inflammatory cytokines

Question 26

What mem is disrupted in each type of TBI

Answer 26

Short term - mild and mod Long term - severe

Question 27

What two parts of the brain does severe TBI involved with memory

Answer 27

Hippocampus and prefrontal cortex

Question 28

What type of memory does each part of the brain involve: Prefrontal cortex Amygdala Hippocampus Cerebellum

Answer 28

Prefrontal cortex: working mem Amygdala: emotional mem Hippocampus: episode mem Cerebellum: procedural mem

Question 29

What assists with mem formation

Answer 29

Rehab physical activities

Question 30

What 3 types of info can be decreased due to loss of synaptic signaling for mem

Answer 30

Spatial info, non-spatial (ID), actions

Question 31

What is the norm range for ICP

Answer 31

7-15 mmHg

Question 32

3 things to look out for regarding ICP

Answer 32

HA, pupillary changes, loss of consciousness**

Question 33

What is one intervention/equipment that can help decrease ICP

Answer 33

External ventricular drain

Question 34

What is cerebral perfusion pressure? How much needed to fxn?

Answer 34

Amount of blood perfusion in brain; >60

Question 35

What is acute hydrocephalus

Answer 35

Blood accumulated in ventricles (requires EVD)

Question 36

What was the GET up trial? Results?

Answer 36

-study of early mob vs bed rest with burr hole craniotomy -early mob had less complications, improved recovery

Question 37

Level 1 Rancho

Answer 37

No response

Question 38

Level 2 rancho

Answer 38

Person reacts inconsistently, not directly to stimuli

Question 39

Level 3 rancho

Answer 39

Localized response, reacts inconsistently, directly to stimuli

Question 40

Level 4 rancho

Answer 40

Confused/agitated, extremely confused

Question 41

Level 5 rancho

Answer 41

Confused, inappropriate, responds inaccurately to commands

Question 42

Level 6 rancho

Answer 42

Confused, appropriate, responds accurately to commands

Question 43

Level 7 rancho

Answer 43

Automatic appropriate; minimal confusion, goes through routine

Question 44

Level 8 rancho

Answer 44

Purposeful appropriate; functioning mem, responsive to environment

Question 45

Level 9 rancho

Answer 45

Purposeful appropriate; daily routine, aware of SBA

Question 46

Level 10 rancho

Answer 46

Purposeful appropriate/mod independent

Question 47

What are the 3 ranges for Glasgow

Answer 47

Mild: 13-15 Moderate: 9-12 Severe: < 9

Question 48

What is persistent vegetative state

Answer 48

Decreased responsiveness with no cerebral cortical function

Question 49

Time ranges for LOC

Answer 49

Mild: 0-30 min Moderate: > 30 min, < 24 hours Severe: > 24 hours

Question 50

What is a decompressive craniectomy

Answer 50

Drill and freeze part of skull; keep brain exposed to decrease edema

Question 51

What 2 things indicate ICP monitoring

Answer 51

Glasgow equal or less than 8 Abnorm brain CT