TBI

Question 1

what is a TBI

Answer 1

traumatic brain injury
neurological insult resulting from mechanical force

ranges from mild (concussion) to severe (DAI, epidural hematoma)

Question 2

ICP

Answer 2

intercranial pressure
the force that keeps blood out
pressure of fluid in between brain and skull

Question 3

cerebral perfusion pressure (CPP)

Answer 3

amount of pressure needed to maintain blood flow to brain
>60 ideal
maintained by IV fluids and vasopressors

Question 4

primary injury

Answer 4

from force of impact

Question 5

secondary injury

Answer 5

arises from primary, systemic response ex: hypoxia and ischemia

Question 6

s/s of brain injury
(include vitals)

Answer 6

decreased LOC
skull deformity
CSF drainage
raccoon eyes
unequal pupils
resp changes
SBP increases and HR decreases
sensory and motor defects

Question 7

diagnosis of TBI

Answer 7

neuro exam
skull and spinal x ray
CT scan
MRI
PET scan

Question 8

assessment for TBI

Answer 8

HH- injury, time, cause, direction of blow
baseline assess
LOC (GCS)

Question 9

priorities for TBI pts

Answer 9

maintain airway
adequate perfusion
fluid and electrolyte balance
adequate nutrition
prevent secondary injury
prevent pressure inj
prevention of sleep deprivation

Question 10

complications of TBI

Answer 10

decreased cerebral perfusion
cerebral edema and herniation
impaired oxygenation and ventilation
impaired fluid, electrolyte, nutrition
seizures

Question 11

causes of increased ICP

Answer 11

increased brain volume
increased blood volume (hyperemia, vasodilation from hypercapnia, obstructed venous outflow)
increased CSF

Question 12

s/s of increased ICP

Answer 12

decreased LOC, deterioration of motor function, pupilary changes, changes in vitals

Question 13

management of increased ICP

Answer 13

elevate HOB
C spine
maintain body temp
maintain PaO2 >90
maintain fluid balance
avoid noxious stim (suction and pain)
sedate
I and O, weight

Question 14

medical mgmt for ICP

Answer 14

anti-seizure
coma inducing drugs
diuretics

Question 15

surgery for TBI

Answer 15

remove clots
repair skull fractures
stop brain bleed
crainectomy

Question 16

GCS for mild, moderate, and severe

Answer 16

mild: 13-15
moderate: 9-12
severe: 8 or less

Question 17

bedside neuro assessment

Answer 17

LOC, motor function, pupils, resp function, vitals, GCS

Question 18

tier 1 approach to ICP

Answer 18

analgesic
raise HOB
control hyperthermia

Question 19

tier 2 approach to ICP

Answer 19

CSF drainage
mannitol
CT imaging

Question 20

tier 3 approach to ICP

Answer 20

neuromuscular blockade
barbituates
craniectomy (removes part of skull)

Question 21

controlling what factors optimizes CPP

Answer 21

venous return
BP
temp