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444-Oncology and Neurology > TBI > Flashcards

TBI Flashcards

1
Q

define TBI

A

disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head or a penetrating head injury

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2
Q

how to assess severity of a TBI

A

glasgow coma score

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3
Q

4 points of eye response in CGS

A

No eye opening
Eye opening to pain
Eye opening to verbal command
Eyes open spontaneously

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4
Q

5 points of verbal response in CGS

A

no response
incomprehensible sounds
inappropriate words
confused
oriented

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5
Q

6 points of motor response in CGS

A

no response
extension to pain
flexion to pain
withdrawal from pain
localizing to pain
obeys commands

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6
Q

what CGS is mild TBI

A

13-15

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7
Q

what CGS is severe TBI

A

3-8

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8
Q

most common cause of TBI is

A

falls

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9
Q

are M or F more likely to experience TBI

A

M

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10
Q

describe mechanisms of primary injury in TBI

A

contact: impact or penetration
sudden acceleration/ decceleration

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11
Q

3 types of injury in TBI

A

focal
diffuse
mixed

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12
Q

what is secondary injury

A

brain cells continue to die after primary injury in min-days following

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13
Q

Intracranial hemorrhage, subarachnoid hemorrhage, subdural hematoma leads to

A

hydrocephalus and vasospasm

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14
Q

systemic hypotension results in

A

decreased perfusion

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15
Q

impaired cerebral vascular autoregulation results in

A

↑BP = ↑ CBF, ↓BP = no perfusion, lacks regular regulation even when BP fluctuates

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16
Q

in TBI there is increased metabolic demand due to

A

seizures, fever, agitation

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17
Q

Free radicals, excitotoxicity, disruption of BBB → _________ → ______

A

cerebral edema

↑ICP

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18
Q

5 predictors of poor outcome from TBI

A

older age
lower CGS score
abnormal pupillary response
systemic hypotension
abnormalities on CT scan

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19
Q

target SBP in TBI

A

> 90

20
Q

target MAP in TBI

A

> 60

21
Q

target O2 sat and PaO2 in TBI

A

> 90%
60

22
Q

how to improve SBP and MAP in TBI

A

fluid resus
vasopressors if fluids fail

23
Q

how to improve O2 sat and PaO2

A

mechanical ventilation

24
Q

surgical interventions for TBI include

A

external ventricular drainage
surgical evacuation of intracranial hematomas
surgical removal of foreign bodies
decompressive craniectomy

25
Q

EVD is to

A

monitor ICP or control hydrocephalus

26
Q

why is sedation done in TBI

A

to control agitation + pain and facilitate mech ventilation
reduce ICP, brain oxygen consumption

27
Q

propofol onset/ offset time

A

fast both

28
Q

propofol MOA

A

GABA-A receptor agonist

29
Q

propofol properties

A

antiseizure
neuroprotective

30
Q

propofol AEs

A

propofol infusion sx
hemodynamic instability
respiratory depression

31
Q

anxiolytic in TBI for sedation

A

midazolam

32
Q

which opioid is used in TBI for sedation

A

fentanyl

33
Q

target CPP

A

> 60mmHg

34
Q

CPP =

A

MAP - ICP

35
Q

target ICP

A

<20mmHg

36
Q

hyperventilation can help control _________ by _________

A

ICP
by causing cerebral vasoconstriction (acute drop in PaCO2 = reflex cosntriction)

37
Q

T or F: hyperventilation in TBI can be used LT to control ICP

A

F- limits blood flow to brain necessary to heal

38
Q

which hyperosmolar agents are used to decrease ICP in TBI

A

mannitol and hypertonic saline

39
Q

mannitol SEs

A

hypotension, ARF

40
Q

mannitol MOA

A

draws water out of cells
decreases blood viscosity resulting in more cerebral blood flow

41
Q

hypertonic saline MOA in TBI

A

increases osmotic gradient to draw water out of cells to decrease ICP

42
Q

in TBI DVT prophylaxis, _______ is initially used then ____ or ____ if not CI

A

pneumatics initially
LMWH and unfractionated heparin

43
Q

infection prophylaxis in TBI is recommended for

A

penetrating head trauma

44
Q

a phenobarb coma is done in TBI to _______ and _______

A

reduce ICP and brain metabolism

45
Q

phenobarbital coma SEs

A

hypotension, decreased GI motility

46
Q

in pts with medically induced hypothermia to reduce ICP, what is important to watch

A

drug dosing- all metabolism slows down

47
Q

T or F: high dose corticosteroids is recommended for reducing ICP in TBI

A

F- increases mortality

444-Oncology and Neurology (22 decks)

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