TBI

Question 1

What are the 3 levels of the cumulative glascow coma scale?

Answer 1

Mild: >13
Moderate: 9-12
Severe: <8

Question 2

What are two surface signs of TBI?

Answer 2

Raccoon eyes or Battle’s sign, which is ecchymosis in the perauricular area beneath the mastoid.

Question 3

What is coup contracoup?

Answer 3

The brain rebounding from a frontal impact to have a posterior impact.

Question 4

Where does an epidural hematoma occur?

Answer 4

Between the dura and the skull.

Question 5

Where does a subdural hematoma occur?

Answer 5

Between the dura and the arachnoid matter.

Question 6

What does a subdural hematoma look like?

Answer 6

A crescent moon, not too wide at any location.

Question 7

What happens during a diffuse axonal injury?

Answer 7

Trauma causes the axon to twist and tear, result in permanent death

Question 8

What are the primary mechanisms of TBI injury?

Answer 8

1. Contusion
   - direct trauma
2. Bleeds
3. Ischemia
4. Laceration
   - tearing
5. Diffuse Axonal Injury

Question 9

What are the mechanisms of secondary injury?

Answer 9

Excitotoxicity:

1. Excessive Ca++
2. Excessive K+ efflux
3. Reduced Mg

O2 free radicals
Cerebral edema (leaky BBB)
>ICP

Question 10

At RLA level VIII, a patient only requires stand by assistance. What are the assistance levels and titles for I-VII?

Answer 10

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

Question 11

What area of the brain (brain stem) governs awake consciousness?

Answer 11

Ponto-mesencephailc reticular formation.

Question 12

How is a coma defined?

Answer 12

State of unarousable unresponsiveness in which there is no evidence of self or environmental awareness.

Question 13

What are some clinical findings unique to coma?

Answer 13

• no spontaneous eye opening
• no sleep/wake cycle
• behavior limited to reflexive activity
• no localized responses or evidence of language comprehension

Question 14

How is a vegetative state different than coma?

Answer 14

Wakefulness w/o arousal
-eye opening

1. No voluntary behavioral responses to stimuli
2. No language comp
3. sleep/wake cycle

Question 15

What acts does someone in VS perform that may be construed as partial consciousness (brainstem intact)?

Answer 15

• grinding teeth
• swallowing
• smiling
• crying
• grunting
• moaning
• orienting

Question 16

What is the timeline of VS?

Answer 16

Persistent VS = 4 weeks after initial VS

Permanent VS = 1 year after persisent.

Question 17

How is someone in a minimally conscious state different than a coma or VS?

Answer 17

Minimal, but definitive behavioral evidence of self or environmental awareness

1. Follow simple commands
2. Gesture yes/no
3. Intelligible verbalization
4. Movement or behavior that occur in response to stim
   - example of pt crying to same sad story

Question 18

How do you know someone has emerged from their MCS?

Answer 18

Demonstration of interactive communication or functional object use

• at least 6 situational orientation questions
• 2use 2 items on 2 different occasions

Question 19

What are the classifiers of being legally brain dead?

Answer 19

• no evidence of function on clinical exam
• no pain response
• no cranial reflexes
• no spontaneous respirations
• flat EEG

Question 20

What is normal and dangerous ICP?

Answer 20

Normal = 7-10 mmHg
>20 = shunt
>25 = life threatening

Question 21

What are good prognostic indicators of TBI?

Answer 21

• GCS >8 in 24 hours
• LOC <40
• no drugs / alcohol

Question 22

Length of ___ is a measure of severity of injury

Answer 22

Post Traumatic Amnesia

Question 23

T/F: 20% of post TBI’s have post-traumatic epilepsy.

Answer 23

True.

Question 24

T/F: Cognitive changes are not the single most important predictor of disability after TBI.

Answer 24

False. They are.