Neuromuscular TBI, mTBI, PCS Flashcards
What are the leading causes of TBI?
- Falls 32%
- Motor Vehicle accidents 19%
- Struck by or against an object 18%
- Assault 10%
What are the causes of brain injury between the ages of 5-65?
The most common cause of TBI between 5-65yrs is Motor Vehicle Accidents (MVA)
What are the causes of brain injury between the ages of 5 and over 65?
The most common cause of TBI between 5 and over 65 yrs is falls
What are the ages for children and adolescents that are at highest risk for TBI?
Children 0-4
Adolescents 15-19
What is the Etiology of TBI?
It can either be Open Head Injury or Closed Head Injury
What is the Pathophysiology of TBI?
Primary Brain injury-damage occurs at the moment of impact, they may exhibit:
- Focal Brain Injury
–Coup-contrecoup injury
–Polar Brain Injury - Blast Injury
- Diffuse Axonal Injury (DAI)
With TBI, what is a Focal Brain Injury?
Coup-Contrecoup Vs Polar Brain injuries.
These injuries occur at the site of impact. Damage may take the form of a contusion or laceration or both.
- Coup-contrecoup: If the brain is hit hard enough, the brain will bounce and make contact with the skull at the opposite site of the local brain damage. (Coup=the injury that occurs within the first point of contact. Contrecoup= the injury on the opposite side)
- Polar Brain injury: Occurs in response to an acceleration, deceleration as well as rotational forces (Common in head on collisions), the frontal and temporal lobes are most susceptible to injury
With TBI, what are Blast Injuries?
Defined as an explosive device that may detonate and a transient shockwave is produced and causes the brain damage.
- Result from the direct effect of blast overpressure on the brain
- Secondary injury results from the shrapnel and other objects being hurled at the individual
- Tertiary injury the patient is being pushed or flung backwards and hitting an object
With TBI, What is Diffuse Axonal Injury (DAI)?
These occur in response to acceleration, deceleration as well as rotation and occur in conjunction with focal and polar brain injuries
With Diffuse Axonal Injury, What is the affect of rapid movement of the brain within the skull? What happens if the damage is severe?
This causes widespread stretching and tearing of the neuronal axons within the myelin sheath. This is labeled as the patient having subcortical white matter shearing.
- If the injury is severe, damage will extend to the brainstem and lead to coma and abnormal posturing
- Not usually evident on CT or MRI, if the pt. is exhibiting DAI, this is found during the neurological exam
With TBI, what are secondary Brain Damage?
These occur within minutes to hours after injury, this involves Intracranial Hematomas (Intracranial pressure occurs and blood accumulates leading to a shifting and compression of brain structures leading to secondary brain damage)
- Other types of secondary brain damage include herniations, Hypoxic-ischemic injury, Post-traumatic epilepsy/seizures, and intracranial infection
What are the different types of hematomas that may occur with secondary brain damage?
- Epidural Hematoma: where blood accumulates on the top of the dura, usually associated with medial meningeal artery damage
- Subdural Hematoma: where venous blood accumulates beneath the dura, common in the elderly related to brain shrinking and the individual having excessive movement of the brain that can occur in a fall or an MVA.
- Intracerebral Hematoma: An intrinsic cerebral arterial blood that accumulates within the brain, usually the most deadly type of hematoma because of the location
With secondary brain damage, what are herniations and the different types?
Herniation: where the brain starts pushing through the foramen magnum, the different types of herniations are:
- Uncal
- Central
- Tonsillar
What is the Medical Management for TBI?
- Neuroimaging: CT and MRI
- Restoration of vital function and prevention of secondary brain damage is top priority
- Glasgow Coma Scale (GCS) is used to determine severity of injury
- ICP is monitored via a catheter into the brain
One of the medical management for TBI is the monitoring of ICP. What is normal ICP and when is it a red flag or a danger?
- Normal ICP is 4-15 mmHG
- After TBI, 15-20 mmHG is expected
- > 25mmHG is a Red Flag and measures will be taken to reduce the pressure
- Danger >40mmHG because impaired blood flow to the brain can cause secondary injury
If ICP goes above 20mmHG notify the nurses &/or doctor and modify intervention
If ICP goes above 30mmHG immediately STOP all interventions and notify nurses and doctors
What is the Sequlae of TBI?
Neuromuscular Impairments
Cognitive Impairments
Neurobehavioral Impairments
With the Sequlae, what are common impairments with Neuromuscular Impairments?
- Paresis
- Abnormal Tone
- Motor Function
- Postural Control
With the Sequlae, what are common impairments with Cognitive Impairments?
- Arousal Level
- Attention
- Concentration
- Memory
- Learning
- Executive functions
With the Sequlae, what are common impairments with Neurobehavioral Impairments?
- Agitation/Aggression
- Disinhibition
- Apathy
- Emotional lability
- Mental Inflexibility
- Impulsivity
- Irritability
- Communication
- Swallowing
With Perceptual and Cognitive Impairments with TBI, what is orientation?
Orientation: Understanding of person (last to lose), place, and time (first to lose)
With perceptual and Cognitive Impairments with TBI, what is memory? Short term vs. Immediate recall vs. Long term memory.
Memory: the ability to store and retrieve information and past experiences
- Short term: Took place a few minutes, hours, or days ago
- Immediate Recall: Recall after a few seconds
- Long-term: Recall of events that occurred years ago
With perceptual and Cognitive Impairments with TBI, What is Lethargy, Obtunded, Stuper, and Coma?
- Lethargy: Altered consciousness in which a person’s level of arousal is diminished; drowsy but able to answer
- Obtunded: Diminished arousal and awareness; difficult to arouse and when aroused is confused
- Stuper: Altered mental status and responsiveness to one’s environment; can only be aroused with vigorous stimuli
- Coma: Unconscious patient, can not be aroused, eyes remain closed, no sleep wake cycles
What are specific cognitive impairments that are unique to TBI?
They deal with the altered levels of consciousness:
- Coma: Arousal state not functioning,No sleep/wake cycle, Not usually permanent
- Vegetative State: Disassociation between wakefulness and awareness, Sleep/wake cycles are present, patient will demo reflexive, non-purposeful responses
- Minimally conscious state (MCS): The patient will now exhibit localization to stimuli and may inconsistently reach for objects