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NeuroRehab > TBI Acute - Fraser > Flashcards

TBI Acute - Fraser Flashcards

"Examining the Three T's of Brain Trauma Treatment: Time, Team, and Technique".

1
Q

Three T’s in TBI

A
  1. Time
  2. Team
  3. Technique
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2
Q

What is the Glasgow Coma Scale

A

Eye opening: 1. None, 2. to pain, 3. to speech 4. spontaneous
Verbal: 1. None 2. Incomprehensible 3. Innapropriate 4. confused 5. Oriented
Motor 1. None 2. Extensor (decerebrate) 3. Flexor (decorticate) 4. withdraws to pain 5. localizes to pain 6. follows commands

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3
Q

Max possible if intubated:

Operational definition of Coma:

A

10T

< or = 8

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4
Q

GCS: No eye opening/speech, withdraws only

A

6

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5
Q

GCS: Intubated, opens eyes to speech, follows commands

A

9T

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6
Q

GCS: Intubated, Flexor posturing, Does not open eyes.

A

4T

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7
Q

GCS: opens eyes, localizes to pain, incoherent

A

9

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8
Q 
GCS history: 
First described: 
Inter-rater reliability: 
Sensitivity:
Specificity:
A
  1. 1974
  2. 88.5-98%
  3. 79-97% sensitive
  4. 84-97% specific
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9
Q

How is GCS used (treatment decisions)

A

intubation
ICP monitoring
Dicision for surgery

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10
Q

Cerebral perfusion pressure:

A

CPP = MAP - ICP

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11
Q

Normal Adult ICP

A

<10-15mmHg

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12
Q

Normal Adult Central perfusion pressure (CPP)

A

> 50mmHg

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13
Q

Indication to treat ICP?

A

Sustained ICP > or = 20-25mmHg

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14
Q

What is Cushing’s Triad?

Percentage of time present in patient’s with high ICP?

A
  1. HTN 2. Bradycardia 3. Irreg respirations

33% of the time.

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15
Q

Indications for ICP monitor (3)

A
  1. GCS < or = 8 (confounded by abnl head CT or age > 40yoa, SBP <90mmHg, or flexor/extesnor posturing or possibly if not following commands)
  2. Multiple organ tissue damage requiring treatments that increase ICP or compromise neuro exam
  3. subsequent to removal of intracranial mass/hemorrhage
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16
Q

Routine interventions for elevated ICP (4)

A
  1. HOB 30-45 degrees
  2. Normotension
  3. pCO2 35-40mmHg
  4. Noncon head CT
17
Q

Interventions for persistently elevated ICP (4)

A
  1. Hyperosmolar solution (mannitol vs HTS)
  2. EVD drainage
  3. Pentobarbital coma - barbituates decrease cerebral metabolic rate and thereby lower CBV and ICP. Free-radical mediated cell injury may also be limited.
  4. Surgical decompression
18
Q

Most common entry point for ventriculostomy? Measurements?

A

Kocher’s point: 11cm posterior to nasion and 3cm lateral to midline

19
Q

For brain tissues oxygenation, keep MAP > ?
Why?
What if MAPs are 150mmHg?

A

60mmHg
At this MAP the cerebral vessels are maximally dilated. (vasodilatory cascade zone). below this, ischemia occurs; MAP >150mmHg can lead to ischemia, disruption of BB barrier, and increased ICP.

20
Q

Ideal location for LICOX device:

What does it do?

A
  1. Arterial watershed; pneumbra through burrhole
  2. easures Oxygen tension and temperature through one probe. Has a semipermeable membrane which allows O2 to pass through and combines with a solution which produces electrical stimulus. Can measure an area of 18mm squared. (reserved for GCS <8 or those high risk for vasospasm)
    - normal PbtO2 25-35mmHg.
21
Q

Types of skull fracture (3)

A

Linear
Depressed
Basal

22
Q

Surgical indications to repair depressed skull fractures: (4)

A
  1. > 8-10mm depression
  2. Underlying deficit
  3. CSF leak
  4. +/- open fracture
23
Q

Four clinical signs of basal skull fx

Radiograph findings?

A
  1. otorrhea/rhinorrhea
  2. hemotympanum
  3. Battle’s sign “raccoon eyes”
  4. CN injury (I/II/VI/VII/VIII)

Sinus opacification
pneumocephalus

24
Q

Most common source of epidural bleed?

Presentation?

A
  1. middle meningeal artery

2. LOC, lucid interval, obtundation

25
Q

What is Kernohan’s Phenomenon?

Associated with?

A
  1. Ipsilateral hemiparesis due to uncal herniation causing compression of the contralateral cerebral peduncle.
  2. epidural hematoma
26
Q

Underlying brain injury worse in SDH or EDH

A

SDH

27
Q

What accounts for majority of penetrating brain injuries?

A

Gunshot wounds

28
Q

What are the late complications of GSW brain injuries? (4)

A
  1. abscess
  2. aneurysm
  3. Seizures
  4. Migrating bullet fragments
29
Q

In peds, if ICP monitor placed in <4hrs:

A

shorter LOS and ICU stay

30
Q

Difference between early and late tracheostomy

A

Shorter ICU stays 19 +/- 7.7 days vs 25.8 +/- 11.8.
No difference between groups in ventilator days, mortality, incidence of PNA, total hospital stay, discharge to rehab,or total cost.

NeuroRehab (12 decks)

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