TBI

Question 1

Definition: Traumatic brain injury

Answer 1

An acute brain injury resulting from mechanical external forces, such as severe acceleration and deceleration, impact, blast, penetrating injury of the head.

Question 2

TBI can be categorised into 2 broad injury groups: Primary injury … ____________; Secondary injury … ___________, and both injury can be _____… contact forces (_______) or ________… acceleration-deceleration (__________)

Answer 2

• damages occur at the time of the impact
• caused by lack of O2
• Focal, contusion
• Diffused, brain swelling

Question 3

Causes: TBI

Answer 3

• Motor vehicle accident (coup … site of impact vs countercoup … opposite side)
• Falls (elderly > 75)
• Contact sports
• Violence

Question 4

Risk factors: TBI

Answer 4

• adolescent male (3:1)
• elderly (fall)
• risk taking behaviour
• young infants (i.e. shaken baby syndrome)

Question 5

TBI occurs ____ a day

Answer 5

72

Question 6

Clinical features: TBI

Answer 6

Dependent of the lesion location and severity, diffused o focal, mechanism of injury; however, initial symptoms may include, nausea, headache, double vision, dizziness, memory problem, extreme fatigue.

Question 7

To be classified as TBI, one or more of the following has to be present

Answer 7

• conusion or disorientation
• loss of consciousness
• post-traumatic amnesia
• other neurological abnormalities like seizure.

Question 8

Type of TBI is classified as Open (10%) and Closed (90%), and Severity can be classified by _______ or _______.

Answer 8

-Glasgow Coma Scale: 3 - 15 points scale
Severe: 3-7, Moderate: 8-12, Mild: 13-15
-Post-Traumatic Amnesia (PTA)
Severe: 1-4weeks, Moderate: 1-24hrs, Mild: <5min

Question 9

Medical management of TBI includes

Answer 9

• prevention of secondary complications
• prevent hypoxia (SpO2 > 90%), hyperthermia, seizure
• maintain intracranial pressure, mean arterial pressure

Question 10

Outcome measures used for TBI

Answer 10

• Glasgow Coma sclae: assess the initial severity of a brain injury by checking a person’s ability to follow directions and move their eyes and limbs. 15points, less points = more severe
• Functional Independence Measure (FIM): assesses physical and cognitive disability, which is a basic indicator of severity of disability; comprises 18 items, Total score:18-126, high score = more independently the patient is able to perform the tasks assessed by that item. (activity independent vs need for assistance from another person or a device)