TBI Flashcards
how often are neuro check performed during early medical management of a TBI?
every 15-30 mins
what are the 3 components of the Glasgow Coma Scale?
eye opening
best motor response
verbal response
what is the lowest Glasgow Coma Scale score? highest?
lowest - 3
highest - 15
a Glasgow Coma Scale score of ____ indicates severe injury
3-8
Glasgow Coma Scale score of ___ indicates moderate injury
9-12
Glasgow Coma Scale score of ___ indicates mild injury
13-15
what does a Glasgow Coma Scale score of “T” mean?
cannot be scored
what are the limitations of the Glasgow Coma Scale?
pre-existing conditions (language)
aphasia
alcohol or other meds
other injuries
what is a local brain injury?
localized to the site of the impact on the skull
what is a diffuse brain injury?
widely scattered shearing of axons
(DAI)
what causes DAI?
high velocity impact
what are the primary brain insults?
local brain injury
diffuse brain injury (DAI)
what are the secondary brain insults?
raised ICP
intracranial infection
cerebral arterial vasospasm
hydrocephalus
post-traumatic epilepsy
brain edema
arterial hypoxemia
arterial hypotension
anemia
hyponatremia
intracranial hematoma
what is normal ICP?
0-10 mmHg WHILE SUPINE
what is abnormal ICP?
20 mmHg
what ICP is a contraindication to PT?
above 20 mmHg
what ICP causes neurologic dysfunction?
20-40 mmHg
what ICP causes death (almost always)?
60 mmHg
if a patient has a transcranial doppler result of a velcity over 100, what can be done in PT?
no OOB activities
supine exercises OK
ventricle will appear ____ with hydrocephalus
bigger
brain edema will causes the ventricles to appear ____
smaller
what condition is present in 1/3 of TBIs presenting to the ER and can be due to depressed breathing centers or drowning?
arterial hypoxemia
what condition is seldom produced in a TBI but can occur with GSW, long bone fx, and liver laceration?
arterial hypotension
what structures are hypoxic and ischemic brain damage most commonly seen in?
hippocampus
basal ganglia
scattered sites of cerebral cortex
cerebellum
(parts that requires the most O2)
which is more localized? hypoxia or ischemia?
ischemia
what color is normal CSF?
clear
what is the purpose of a ventriculostomy?
measures and drains CSF
via external ventricular drain (EVD)
what is the purpose of a bolt?
measures ICP only
the pressure transducer of an EVD should be level with ___
external auditory meatus
what must occur to the EVD prior to mobilization?
must be clamped
if can’t clamp, must have nurse to move it constantly
what meds can be given to TBI patients?
anti-convulsant
corticosteroids
sedatives/anesthetics
skeletal muscle relaxants
skeletal muscle paralytics
CV meds
antibiotics
narcotic analgesics
what are some treatments for a raised ICP?
osmotic therapy (diuretic)
sedative/hypnotic
vasoreductive therapy (hyperventilation)
skeletal muscle paralytics &/or relaxants
core temperature/therapeutic hypothermia
what is a sign of irritation with brain herniation?
fever
what can be caused by damage to the hypothalamus?
fever (“neurogenic fever”)
what causes intracranial hypertension?
loss of autoregulation of cerebral blood flow increases blood-brain volume
systemic arterial hypertension can be caused by
noxious stimuli
systemic arterial hypertension can result in
blood-brain barrier disruption and causes more brain edema
what is the most common cardiac symptom of TBI?
tachycardia
what regions control heart rate?
diencephalon
(caudally to myelencephalon (medulla))
when is recovery most rapid after a TBI?
1 year post
when is recovery most rapid after a stroke?
3-6 months
which scale is used to track individuals from coma to community?
disability rating scale (DRS)
scored from 0-30
addresses impairment, disability, & handicap
which outcome measure assesses the ability to fulfill life roles & ecologically support self?
Craig Handicap Assessment & Reporting Technique (CHART)
what are the categories for Craig Handicap Assessment & Reporting Technique (CHART)?
physical independence
mobility
occupation
social integration
economic self-sufficiency
cognitive independence
what outcome measure looks at the importance of the ability to do certain activities?
participation objective/participation subjective (POPS)
what are the categories for the participation objective/participation subjective (POPS) scale?
domestic life
major life activities
transportation
interpersonal interaction and relationships
community, recreational, and civic life
what are major predictors of TBI outcome?
degree and duration of LOC
post-traumatic amnesia
which outcome scale can be added to the FIM for TBI & CVA?
FAM
which outcome scale is designed to assess high-level motor performance in patients with TBI
hi-level mobility assessment tool (HiMAT)
what are the minimum mobility requirements for the HiMAT?
independent walking 20 meters without gait aids
what is a Rancho level 1?
no response
unresponsive to stimuli
definition of a coma
what is a Rancho level 2?
generalized response
non-purposeful response to pain only
what is a Rancho level 3?
localized response
purposeful response
simple commands, focus on object
what is a Rancho level 4?
confused, agitated
what is a Rancho level 5?
confused, inappropriate, non-agitated
in PTA stage
what is a Rancho level 6?
confused, appropriate
can relearn old skills (ADLs)
in PTA stage
what is a Rancho level 7?
automatic, appropriate
minimal confusion
what is a Rancho level 8?
purposeful, appropriate
alert, oriented
cognitively independent in living skills
capable of driving
which Rancho level is the first stage out of PTA?
7
which Rancho level is the first stage capable of driving?
8
difference between coma and PVS?
coma - appears asleep, doesn’t move
lasts 2 weeks max
Rancho 1
PVS - sleep/wake cycles
can last indefinitely
Rancho 2-3
which Rancho level is a minimally conscious state?
3
which outcome can differentiate Rancho levels and detect minimally conscious state?
JKF coma/near coma scale
which outcome scale is a huge implication for d/c placement from acute care for coma patients?
JKF coma/near coma scale
what is post-traumatic amnesia (PTA)?
period of time from the accident to the time that the patient starts to have on-going short-term memory
how long does PTA generally last?
3-4 times the length of unconsciousness
which outcome scale is used to determine when a patient is progressing out of PTA?
Galveston Orientation & Amnesia Test (GOAT)
what GOAT score must a pt have to be considered out of PTA?
3 consecutive scores of >75
which regions can lead to agitation if injured?
fronto-orbital
anterior temporal lobes
Sylvian fissure
temporal lobes seizures
DAI of corpus callosum & dorsolateral columns of midbrain
secondary effects of ____, ____, and ____ can cause agitation
hypoxia
compression
neurohormonal effects
what type of activities should be done in PT with an agitated pt?
automatic activities
what is an observational tool to assess the extent of agitation during acute phase of recovery from TBI?
agitated behavior scale
what is an observational tool to measure attention-related behaviors after TBI?
Moss attention rating scale
(not for coma or PVS)
definition of mild TBI (factors)
traumatically induced disruption of brain function as manifest by at least one:
- any period of LOC
- loss of memory for immediate pre and
post events
- change in mental state at time of
accident
- focal neuro deficits (transient or lasting)
severity of mild TBI does not exceed:
LOC:
GCS after 30 mins:
PTA:
LOC: ~30 mins
GCS: 13-15
PTA: 24 hrs
what is the most commonly reported symptom of mild TBI?
HA
