TBI

Question 1

Open Injury

Answer 1

• injury of direct penetration through the skull to the brain
• ex: GSW, knife or sharp object penetration, skull fragments and direct trauma

Question 2

closed head injury

Answer 2

• 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

Question 3

primary injury

Answer 3

• initial injury to the brain sustained by impact

Question 4

coup-countercoup

Answer 4

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

Question 5

secondary inury

Answer 5

• brain damage that occurs as a response to the initial injury
  EX: hematoma, hypoxia, ischemia, incr intracranial pressure and post-traumatic epilepsy
  -

Question 6

epidural hematoma

Answer 6

a hemorrhage that forms between the skull and dura mater

Question 7

subdural hematoma

Answer 7

• hemorrhage that forms due to venous rupture between the dura and arachnoid

Question 8

Concussion grade 1

Answer 8

• 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

Question 9

concussion grade 2

Answer 9

• 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

Question 10

concussion grade 3

Answer 10

• 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

Question 11

Rancho Los Amigos levels of cognitive function

1.

Answer 11

No response

- patient appear to be in a deep sleep and is completely unresponsive to any stimuli

Question 12

Rancho Los Amigos levels of cognitive function

2.

Answer 12

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

Question 13

Rancho Los Amigos levels of cognitive function

3.

Answer 13

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

Question 14

Rancho Los Amigos levels of cognitive function

4.

Answer 14

• 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

Question 15

Rancho Los Amigos Levels of Cognitive Function

5.

Answer 15

• 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

Question 16

Rancho Los Amigos Levels of Cognitive Function

6.

Answer 16

• 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

Question 17

Rancho Los Amigos Levels of Cognitive Function

7.

Answer 17

• 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

Question 18

Rancho Los Amigos Levels of Cognitive Function

8.

Answer 18

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

Question 19

Glascow coma scale – total scores

Answer 19

• 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

Question 20

GCS eye opening

Answer 20

Spontaneous- 4
To speech- 3
To pain- 2
None- 1

Question 21

GCS Best motor response

Answer 21

obeys commands- 6 
localizes pain - 5
withdraws- 4
abnormal flexion- 3
extensor response - 2
None- 1

Question 22

GCS Verbal response

Answer 22

Oriented - 5
confused conversation - 4
inappropriate words - 3 
incomprehensible sounds - 2
None- 1