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Recapping > TBI > Flashcards

TBI Flashcards

1
Q

leading cause of TBI

A

Falls (elderly) vs MVA (children)

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2
Q

TBI demographic

A

single, white, undereducated, teen to 25 yo, male

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3
Q

cerebral profusion pressure equation

What value keep CPP?

A

CPP = MAP - ICP

CPP>60mmhg
Keep ICP <20mmhg

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4
Q

Managing ICP

A

nl range 2-5, keep under 20

  1. force hyperventilation (decrease PaCO2-> vasoconstriction-> less flow)
  2. hypothermia
  3. Meds: IV mannitol or acetazolamide
  4. emergency- burr hole, craniotomy
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5
Q

Primary injury
Contusion
Diaschisis
DAI

A

immediate concussive force
brain bruises at “horns” of brain. usually at inf frontal lobe and ant temp lobe
“split across”- damage area damages remote region connected
“Diffuse Axon Injury”

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6
Q

DAI- causes, most common locations

A

diffuse axonal injury
axon injury 2.2 concussive blat to head and shears axon leading to central white matter damage. white on diffusion weighted MRI. Usually seen at central white matter, brain stem, corpus callosum

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7
Q

DAI grading

A

Using MRI criteria
1- no focal change
2- focal change
3- brain stem involvement

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8
Q

Secondary injury

A

biochemical cascade after primary injry

  • excitatory toxicity (glutamate): massive neurotransmitte r surge and burn out
  • Brain swelling- CT shows decrease ventricle size
  • Brain edema - longstanding, blood vessel damage, fluid leak out of brain tissue
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9
Q

Posturing
decorticate
decerebrate

A

deCORticate: arms flexed, legs extended. lesion at brainstem
Decerebrate: arms extended, leg extended. lesion at midbrain. (worse due to brainstem involvement)

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10
Q

Epidural hematoma

A

Lens
middle meningeal artery
no midline shift
lucid then downhill

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11
Q

Subdural hematoma

A

Crescent
bridging vein
bleed between dura and arachnoid

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12
Q

subarachnoid hemorrhage

A

bleeding in subarachnoid space
rupture AVM or berry aneurysm (usually Acomm or Pcomm)
give nimodipine x 21days for cerebral vasospasm

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13
Q

C1 injury

A

smell, most common injury

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14
Q

C2

A

visual field

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15
Q

C7

A

deficit at ant 2/3 tongue, facial expression, salivation, tears

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16
Q

C8

A

hearing loss and balance

most dizziness is BPPV

17
Q

what should pts be on after brain radiation tx?

A

steroids

18
Q

Coma

A

eyes closed
no wake/sleep cycle on EEG
no purposeful behavior or comprehension

19
Q

Vegetative state

A 
eyes open
\+ wake/sleep on EEG
no localization of objections
\+ reflexive behavior w/o crossing 
midline
Persistent = >1month
Permanent= >1 year, 3months on nontraumatic (anoxia)
20
Q

Minimally conscious state

A

+eyes open
+wake/sleep
+environmental awareness, purposeful behavior crossing midline but not consistent

21
Q

Treating disorders of consciousness (DOC)

A

supportive

meds increasing dopamine: amantadine, methylphenidate, modafinil

22
Q

Posttraumatic Amnesia -PTA

Test and score

A

cant make memories of daily events

GOAT- Galveston Orientation and Amnesia Test
>75 points for 2 straight days

Orientation log
>25 points for 2 straight days

23
Q

Glasgow Outcome Scale (GOS)

A 
1- dead
2- VS
3- conscious with disability
4-independent with disability
5- independent
24
Q

Rancho Los Amigos

A 
1- no response
2- generalized response
3- localized response
4- confused agitated
5- confused inappropriate
6- confused appropriate
7- automatic appropriate
8- purposeful appropriate

“4 is on the floor” confused agitated pt

25
Q

Posttraumatic seizure

timing

A 
simple partial after TBI
immediate in first day
early 1-7days
late after 7 days
Check prolactin levels, EEG
tx leve or phenytoin
26
Q

Posttraumatic epilepsy

A

recurrent seizures in first week
R/o other causes
caused by foreign body, blood, or bone
Tx AED x1 week for ppx. continue 2 year if late seizure. okay to stop if no seizure for 2 years
Levetiracetam, Carbamazepine, valproate, phenytoin, phenobarbital

27
Q

Posttraumatic hydrocephalus

A

increase pressure
dilated ventricles, N/V/HA/ confusion
tx with VP shunt

28
Q

Dysautonomic/ sympathetic storm

A

sympathetic output
HTN, fever, tachy, sweat intermittently
tx with propanolol, scheduled pain control (tylenol) and dopamine agonist (bromocriptine, amantadine)
-ID work up if SIRS

29
Q

Tx agitation

A

decrease stimuli let pt burn off energy
lesion usually at frontal and temporal lobes
meds: antispychotics/ D2 blockers, haloperidol (slows motor recovery), quetiapine, olanzapine, ziprasidone, rispirodone , watch for metabolic issues and prolonged QT

ABS agitation behavior scale
<21 normal

30
Q

SIADH

A

too much ADH, holding on to too much water
Euvolemic hyponatremia
tx with water restriction

31
Q

CSW- central salt wasting

A

hypovolumic hyponatremia
tachy, low bp, appropriate elevated ADH
tx with iv fluids

32
Q

Diabetes insipitus

A

no ADH, peeing out water, thirsty
Hypernatremia, dilute urine
give ADH

33
Q

Concussion

A

mild tbi: GCS 12-15
Sx: HA, sensory issues, psych, memory, sleep, tired
Brain trauma with LOC < 30mins or PTA < 1 day of AMS or focal neuro deficit

recovers in 1-3 months

34
Q

Return to play protocol

A 
Stages can only proceed if asymptomatic to start
1- do nothing
2- light cardio
3- directional cardio
4- drills: sports specific cardio
5- full practice
6- cleared to play

Recapping (4 decks)

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