TBI Flashcards
Causes of TBI
-Transportation (#1)-Falls-Firearms-Other Assaults-Other/Unknown
Common ages for TBI
- 15-24 (risky behavior/transportation)
- 75+ (falls)
TBI Classifications
- Open
- Closed
- Coup
- Contracoup
- Focal
- Diffuse
- Hypoxic
- Ischemic
- Hematomas
Coup-Contracoup Injury
- Brain hits one part of skull and bounces back to other part
- Tend to involve antero-inferior temporal lobes and prefrontal cortex
Closed TBI
- aceleration deceleration forces
- doesn’t penetrate skull
Open TBI
- Penetrating injury
- Skull penetrated
Focal TBI
- Localized area of injury
- can cause hematoma, edema, contusion, or laceration
- Edema can cause herniation of brainstem–>death
Diffuse TBI
- Shearing and retraction of axons-can cause coma–>poor outcome
- DAI may not show up on imaging (imaging can’t show axon shearing)
Hypoxic-Ischemic TBI
- due to systemic hypotension, anoxia, vascular damage
- can lead to global damage
Hematoma TBI
- bleeding in brain can cause pressure in some areas
- TYPES: epidural, subdural, intracranial
DAI
Diffuse axonal injury
Epidural Hematoma
-between skull and dura mater-often arterial (rapid but not necessarily immediately)-period of normal functioning–>N/V & UMN signs
Subdural Hematoma
- Venous-Develop slowly over time
- UMN signs and confusion-Elderly on blood thinners
Intracranial Hematoma
In the brain
Secondary Damage
- increased ICP
- Infection from open wounds
- Seizures (immediately or up to 6mo-2years to forever; can lead to more damage)
Normal ICP
4-15mmHg-can increase from PT (trendelenburg positions, isometrics, exercise)
Imaging/Diagnostics
- CT: may not detect soon after
- MRI: better resolution than CT
- Neuropsychological Testing (cognitive testing)
Treatment
- Resuscitation/stabilization
- ER
- Eval, neuro exam, diagnostics
- Surgery
- ICP monitoring
- Rehab
Glasgow Coma Scale
- Eye responses
- Verbal responses
- Motor responses
- for comatose pts or emerging from coma
- predictive of long term outcomes
Ranchos Los Amigos Scale Levels
- Scale for cognitive functioning levels-broad scale of appropriateness
- Levels I-VIII
Goals for Levels I-III
- increase alertness-prevent 2* impairments-Improve motor control
- facilitate normal tone
- increase tolerance of positions/activities
- edu family
- coord care among team/family
Sensory Stimulation
- To increase arousal and elicit movement
- various stimulus types-need to document everything
Goals of Level IV
- Prevent outbursts of agitation
- patient safety
- edu family
- mntn/increase physical activity tolerance
- prevent 2* impairments-coordinate care with team/family
Goals of Level V-VI
- increase function/balance/ADL
- motor control-safety-participation
- behave appropriately
- improve impairments (strength/ROM)
Goals of Level VII-VIII
- increase task/ADL perfromance, community functioning, work reintegration, leisure
- improve functional capabilities
- pt manage symptoms
- decreased need for supervision
- increased safety in diff environments
- family member edu
