TBI Flashcards
1
Q
Open Injury
A
- injury of direct penetration through the skull to the brain
- ex: GSW, knife or sharp object penetration, skull fragments and direct trauma
2
Q
closed head injury
A
- injury to the brain without penetration through the skull
- ex: concussion, contusion, hematoma, injury to extracranial blood vessels, hypoxia, drug overdose, near drowning, and acceleration or deceleration injuries
3
Q
primary injury
A
- initial injury to the brain sustained by impact
4
Q
coup-countercoup
A
coup a direct lesion of the brain under the point of impact
- counter coup: injury that results on the opposite side of the brain
- the lesion is due to the rebound effect of the brain after impact
5
Q
secondary inury
A
- brain damage that occurs as a response to the initial injury
EX: hematoma, hypoxia, ischemia, incr intracranial pressure and post-traumatic epilepsy
-
6
Q
epidural hematoma
A
a hemorrhage that forms between the skull and dura mater
7
Q
subdural hematoma
A
- hemorrhage that forms due to venous rupture between the dura and arachnoid
8
Q
Concussion grade 1
A
- there is no loss of consciousness
- symptoms will typically resolve within 15 minutes if the event
- athlete should be removed from the competition and return only if symptom free after one week of rest
9
Q
concussion grade 2
A
- results from mod head injury with transient confusion that will last longer than 15 minutes
- exhibit poor concentration, retrograde and anterograde amnesia
- athlete should be removed immediately and receive medical evaluation
- return to play be deferred until the athlete is asymptomatic for two weeks at rest and with exertion
10
Q
concussion grade 3
A
- concussion that results from head injury with any LOC
- pt should require transport to the ER for a full neurological exam
- hospitalization is warranted if altered consciousness
- athlete should be withheld from competition after a grade 3 concussion once symptom free for a minimum of one month
- if severe can result in coma
11
Q
Rancho Los Amigos levels of cognitive function
1.
A
No response
- patient appear to be in a deep sleep and is completely unresponsive to any stimuli
12
Q
Rancho Los Amigos levels of cognitive function
2.
A
generalized response
- reacts inconsistently and non-purposefully to a stimuli in a nonspecific manner
- Reponses are limited and often the same regardless of stimulus present
- responses may be physiological changes, gross body movements and/or vocalizations
13
Q
Rancho Los Amigos levels of cognitive function
3.
A
Localized response
- reacts specifically but inconsistently to the stimuli
- responses are directly related to the type of stimuli presented
- may follow simple commands such as closing eyes or squeezing hand in an inconsistent delayed manner
14
Q
Rancho Los Amigos levels of cognitive function
4.
A
- confused - agitated
- Pt is in a heightened state of activity
- behavior is bizarre and non-purposeful relative to the immediate environment
- does not discriminate among persons or objects; is unable to cooperate directly with tx efforts
- verbalizations frequently incoherent and/or inappropriate to the environment
- confabulation present
- lack short-term and long term memory
15
Q
Rancho Los Amigos Levels of Cognitive Function
5.
A
- Confused-inappropriate
- Pt is able to respond to simple commands fairly consistent
- however, with incr complexity of commands or lack of any external structure, responses are non-purposeful, random, or fragmented
- demonstrates gross attention to the environment, but is highly distractible and lacks the ability to focus attention on a specific task.
- with structure, may be able to converse on a social automatic level for short periods of time
- verbalization is often inappropriate and confabulatory
- memory is severely impaired; often shows inappropriate use of objects; may perform previously learned tasks with structure, but is unable to learn new information
16
Q
Rancho Los Amigos Levels of Cognitive Function
6.
A
- Confused- appropriate
- Pt shows goal-directed behavior, but is dependent on external input or direction
- follows simple directions consistently and shows carryover for relearned tasks such as self-care.
- responses may be incorrect due to memory problems, but they are appropriate to the situation
- past memories show more depth and detail than recent memory
17
Q
Rancho Los Amigos Levels of Cognitive Function
7.
A
- automatic - appropriate
- pt appears appropriate and oriented within the hospital and home setting
- goes through daily routine automatically, but freq robot-like
- Pt shows minimal to no confusion and has shallow recall of activities
- shows carryover for new learning, but at a decr rate
- with structure is able to initiate social or recreational activities; judgement remains impaired
18
Q
Rancho Los Amigos Levels of Cognitive Function
8.
A
Purposeful- appropriate
- pt is able to recall and integrate past and recent events and is aware of and responsive to environment
- shows carryover for new learning and needs no supervision once activities are learned
- may continue to show a decr ability relative to pre-morbid abilities, abstract reasoning, tolerance for stress and judgement in emergencies or unusual circumstances
19
Q
Glascow coma scale – total scores
A
- a total score of 8 or less correlates to severe brain injury and coma in 90% of patients
- scores of 9-12 indicate moderate brain injuries and scores from 13-15 mild brain injuries
- lowest score is a three
20
Q
GCS eye opening
A
Spontaneous- 4
To speech- 3
To pain- 2
None- 1
21
Q
GCS Best motor response
A
obeys commands- 6 localizes pain - 5 withdraws- 4 abnormal flexion- 3 extensor response - 2 None- 1
22
Q
GCS Verbal response
A
Oriented - 5 confused conversation - 4 inappropriate words - 3 incomprehensible sounds - 2 None- 1
