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Neuro MSK > TBI > Flashcards

TBI Flashcards

1
Q

how often are neuro check performed during early medical management of a TBI?

A

every 15-30 mins

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2
Q

what are the 3 components of the Glasgow Coma Scale?

A

eye opening
best motor response
verbal response

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3
Q

what is the lowest Glasgow Coma Scale score? highest?

A

lowest - 3
highest - 15

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4
Q

a Glasgow Coma Scale score of ____ indicates severe injury

A

3-8

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5
Q

Glasgow Coma Scale score of ___ indicates moderate injury

A

9-12

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6
Q

Glasgow Coma Scale score of ___ indicates mild injury

A

13-15

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7
Q

what does a Glasgow Coma Scale score of “T” mean?

A

cannot be scored

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8
Q

what are the limitations of the Glasgow Coma Scale?

A

pre-existing conditions (language)
aphasia
alcohol or other meds
other injuries

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9
Q

what is a local brain injury?

A

localized to the site of the impact on the skull

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10
Q

what is a diffuse brain injury?

A

widely scattered shearing of axons
(DAI)

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11
Q

what causes DAI?

A

high velocity impact

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12
Q

what are the primary brain insults?

A

local brain injury
diffuse brain injury (DAI)

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13
Q

what are the secondary brain insults?

A

raised ICP
intracranial infection
cerebral arterial vasospasm
hydrocephalus
post-traumatic epilepsy
brain edema
arterial hypoxemia
arterial hypotension
anemia
hyponatremia
intracranial hematoma

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14
Q

what is normal ICP?

A

0-10 mmHg WHILE SUPINE

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15
Q

what is abnormal ICP?

A

20 mmHg

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16
Q

what ICP is a contraindication to PT?

A

above 20 mmHg

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17
Q

what ICP causes neurologic dysfunction?

A

20-40 mmHg

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18
Q

what ICP causes death (almost always)?

A

60 mmHg

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19
Q

if a patient has a transcranial doppler result of a velcity over 100, what can be done in PT?

A

no OOB activities
supine exercises OK

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20
Q

ventricle will appear ____ with hydrocephalus

A

bigger

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21
Q

brain edema will causes the ventricles to appear ____

A

smaller

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22
Q

what condition is present in 1/3 of TBIs presenting to the ER and can be due to depressed breathing centers or drowning?

A

arterial hypoxemia

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23
Q

what condition is seldom produced in a TBI but can occur with GSW, long bone fx, and liver laceration?

A

arterial hypotension

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24
Q

what structures are hypoxic and ischemic brain damage most commonly seen in?

A

hippocampus
basal ganglia
scattered sites of cerebral cortex
cerebellum
(parts that requires the most O2)

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25
Q

which is more localized? hypoxia or ischemia?

A

ischemia

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26
Q

what color is normal CSF?

A

clear

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27
Q

what is the purpose of a ventriculostomy?

A

measures and drains CSF
via external ventricular drain (EVD)

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28
Q

what is the purpose of a bolt?

A

measures ICP only

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29
Q

the pressure transducer of an EVD should be level with ___

A

external auditory meatus

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30
Q

what must occur to the EVD prior to mobilization?

A

must be clamped
if can’t clamp, must have nurse to move it constantly

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31
Q

what meds can be given to TBI patients?

A

anti-convulsant
corticosteroids
sedatives/anesthetics
skeletal muscle relaxants
skeletal muscle paralytics
CV meds
antibiotics
narcotic analgesics

32
Q

what are some treatments for a raised ICP?

A

osmotic therapy (diuretic)
sedative/hypnotic
vasoreductive therapy (hyperventilation)
skeletal muscle paralytics &/or relaxants
core temperature/therapeutic hypothermia

33
Q

what is a sign of irritation with brain herniation?

A

fever

34
Q

what can be caused by damage to the hypothalamus?

A

fever (“neurogenic fever”)

35
Q

what causes intracranial hypertension?

A

loss of autoregulation of cerebral blood flow increases blood-brain volume

36
Q

systemic arterial hypertension can be caused by

A

noxious stimuli

37
Q

systemic arterial hypertension can result in

A

blood-brain barrier disruption and causes more brain edema

38
Q

what is the most common cardiac symptom of TBI?

A

tachycardia

39
Q

what regions control heart rate?

A

diencephalon
(caudally to myelencephalon (medulla))

40
Q

when is recovery most rapid after a TBI?

A

1 year post

41
Q

when is recovery most rapid after a stroke?

A

3-6 months

42
Q

which scale is used to track individuals from coma to community?

A

disability rating scale (DRS)
scored from 0-30
addresses impairment, disability, & handicap

43
Q

which outcome measure assesses the ability to fulfill life roles & ecologically support self?

A

Craig Handicap Assessment & Reporting Technique (CHART)

44
Q

what are the categories for Craig Handicap Assessment & Reporting Technique (CHART)?

A

physical independence
mobility
occupation
social integration
economic self-sufficiency
cognitive independence

45
Q

what outcome measure looks at the importance of the ability to do certain activities?

A

participation objective/participation subjective (POPS)

46
Q

what are the categories for the participation objective/participation subjective (POPS) scale?

A

domestic life
major life activities
transportation
interpersonal interaction and relationships
community, recreational, and civic life

47
Q

what are major predictors of TBI outcome?

A

degree and duration of LOC
post-traumatic amnesia

48
Q

which outcome scale can be added to the FIM for TBI & CVA?

A

FAM

49
Q

which outcome scale is designed to assess high-level motor performance in patients with TBI

A

hi-level mobility assessment tool (HiMAT)

50
Q

what are the minimum mobility requirements for the HiMAT?

A

independent walking 20 meters without gait aids

51
Q

what is a Rancho level 1?

A

no response
unresponsive to stimuli
definition of a coma

52
Q

what is a Rancho level 2?

A

generalized response
non-purposeful response to pain only

53
Q

what is a Rancho level 3?

A

localized response
purposeful response
simple commands, focus on object

54
Q

what is a Rancho level 4?

A

confused, agitated

55
Q

what is a Rancho level 5?

A

confused, inappropriate, non-agitated
in PTA stage

56
Q

what is a Rancho level 6?

A

confused, appropriate
can relearn old skills (ADLs)
in PTA stage

57
Q

what is a Rancho level 7?

A

automatic, appropriate
minimal confusion

58
Q

what is a Rancho level 8?

A

purposeful, appropriate
alert, oriented
cognitively independent in living skills
capable of driving

59
Q

which Rancho level is the first stage out of PTA?

A

7

60
Q

which Rancho level is the first stage capable of driving?

A

8

61
Q

difference between coma and PVS?

A

coma - appears asleep, doesn’t move
lasts 2 weeks max
Rancho 1
PVS - sleep/wake cycles
can last indefinitely
Rancho 2-3

62
Q

which Rancho level is a minimally conscious state?

A

3

63
Q

which outcome can differentiate Rancho levels and detect minimally conscious state?

A

JKF coma/near coma scale

64
Q

which outcome scale is a huge implication for d/c placement from acute care for coma patients?

A

JKF coma/near coma scale

65
Q

what is post-traumatic amnesia (PTA)?

A

period of time from the accident to the time that the patient starts to have on-going short-term memory

66
Q

how long does PTA generally last?

A

3-4 times the length of unconsciousness

67
Q

which outcome scale is used to determine when a patient is progressing out of PTA?

A

Galveston Orientation & Amnesia Test (GOAT)

68
Q

what GOAT score must a pt have to be considered out of PTA?

A

3 consecutive scores of >75

69
Q

which regions can lead to agitation if injured?

A

fronto-orbital
anterior temporal lobes
Sylvian fissure
temporal lobes seizures
DAI of corpus callosum & dorsolateral columns of midbrain

70
Q

secondary effects of ____, ____, and ____ can cause agitation

A

hypoxia
compression
neurohormonal effects

71
Q

what type of activities should be done in PT with an agitated pt?

A

automatic activities

72
Q

what is an observational tool to assess the extent of agitation during acute phase of recovery from TBI?

A

agitated behavior scale

73
Q

what is an observational tool to measure attention-related behaviors after TBI?

A

Moss attention rating scale
(not for coma or PVS)

74
Q

definition of mild TBI (factors)

A

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)

75
Q

severity of mild TBI does not exceed:
LOC:
GCS after 30 mins:
PTA:

A

LOC: ~30 mins
GCS: 13-15
PTA: 24 hrs

76
Q

what is the most commonly reported symptom of mild TBI?

A

HA

Neuro MSK (15 decks)

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