TBI Flashcards
What are the 3 levels of the cumulative glascow coma scale?
Mild: >13
Moderate: 9-12
Severe: <8
What are two surface signs of TBI?
Raccoon eyes or Battle’s sign, which is ecchymosis in the perauricular area beneath the mastoid.
What is coup contracoup?
The brain rebounding from a frontal impact to have a posterior impact.
Where does an epidural hematoma occur?
Between the dura and the skull.
Where does a subdural hematoma occur?
Between the dura and the arachnoid matter.
What does a subdural hematoma look like?
A crescent moon, not too wide at any location.
What happens during a diffuse axonal injury?
Trauma causes the axon to twist and tear, result in permanent death
What are the primary mechanisms of TBI injury?
- Contusion
- direct trauma - Bleeds
- Ischemia
- Laceration
- tearing - Diffuse Axonal Injury
What are the mechanisms of secondary injury?
Excitotoxicity:
- Excessive Ca++
- Excessive K+ efflux
- Reduced Mg
O2 free radicals
Cerebral edema (leaky BBB)
>ICP
At RLA level VIII, a patient only requires stand by assistance. What are the assistance levels and titles for I-VII?
TOTAL ASSISTANCE
I: no response
II: generalized response
III: localized response
MAX ASSIST
IV: confused-agitated
V: confused-innapropriate
MOD ASSIST
VI: confused appropriate
MIN ASSIST
VII: autonomous appropriate
What area of the brain (brain stem) governs awake consciousness?
Ponto-mesencephailc reticular formation.
How is a coma defined?
State of unarousable unresponsiveness in which there is no evidence of self or environmental awareness.
What are some clinical findings unique to coma?
- no spontaneous eye opening
- no sleep/wake cycle
- behavior limited to reflexive activity
- no localized responses or evidence of language comprehension
How is a vegetative state different than coma?
Wakefulness w/o arousal
-eye opening
- No voluntary behavioral responses to stimuli
- No language comp
- sleep/wake cycle
What acts does someone in VS perform that may be construed as partial consciousness (brainstem intact)?
- grinding teeth
- swallowing
- smiling
- crying
- grunting
- moaning
- orienting
What is the timeline of VS?
Persistent VS = 4 weeks after initial VS
Permanent VS = 1 year after persisent.
How is someone in a minimally conscious state different than a coma or VS?
Minimal, but definitive behavioral evidence of self or environmental awareness
- Follow simple commands
- Gesture yes/no
- Intelligible verbalization
- Movement or behavior that occur in response to stim
- example of pt crying to same sad story
How do you know someone has emerged from their MCS?
Demonstration of interactive communication or functional object use
- at least 6 situational orientation questions
- 2use 2 items on 2 different occasions
What are the classifiers of being legally brain dead?
- no evidence of function on clinical exam
- no pain response
- no cranial reflexes
- no spontaneous respirations
- flat EEG
What is normal and dangerous ICP?
Normal = 7-10 mmHg >20 = shunt >25 = life threatening
What are good prognostic indicators of TBI?
- GCS >8 in 24 hours
- LOC <40
- no drugs / alcohol
Length of ___ is a measure of severity of injury
Post Traumatic Amnesia
T/F: 20% of post TBI’s have post-traumatic epilepsy.
True.
T/F: Cognitive changes are not the single most important predictor of disability after TBI.
False. They are.