TBI and PDOC Flashcards
What is a TBI?
Traumatic brain injury
Direct high energy blow to head, brain hits skull suddenly.
what are the 2 stages?
Primary - injury caused by mechanical forces, axonal injury
Secondary - further tissue and cell damage because of initial injury
What happens in primary brain injury?
White matter tract damage to the brain.
Disconnection/malfunction of neuron interconnection.
Can lead to lower scores on the GCS (<8)
Pathophysiology of tbi
- Ischaemia and Haemorrhage affects blood supply to brain
- No oxygen and no energy for cells to function
- Mitochondrial dysfunction – ATP depletion and overproduction
of ROS (is toxic) - Failure of energy-dependent membrane pump
- Ion imbalance»_space; Accumulation of Na and Ca as well as
Glutamate. - Cells increase due to water»_space; Swelling
- Membrane degradation of vascular and cellular structures and
ultimately necrotic or programmed cell death (apoptosis). - Excitotoxicity due to accumulation and release of glutamate
what is cerebral oedema?
brain swelling that increased intracranial pressure.
What is the medical management of TBI?
Airway management in severe cases.
CT imaging within 30min
Intracranial pressure moniter in 3.1 hrs
Craniotomy in 2.6 hrs
What is PDOC?
prolonged disorder of consciousness longer than 4 weeks post injury.
What causes this?
- Direct trauma
- Vascular event
- Hypoxic or hypo-perfusion
- Infection or inflammation
- Toxic or metabolic
What is coma?
Absent wakefulness and absent awareness
State of unrousable unresponsiveness lasting more than 6 hours in which a person.
What is a vegatative state?
Wakefulness with absent awreness
Preserved capacity for spontaneous or stimulus induced arousal.
sleep wake cycle
VS is characterised by absence of evidence for self
What is minimally conscious state?
A state of severely altered consciousness in which minimal but shows evidence of self or environmental awareness.
inconsistent but reproducible.
What bodily functions
What risks are there with immobility?
Pressure sores,
chest ifections,
contractures
control over bladder bowl
What problems with spasticity?
can lead to contractures
difficult in maintaing hygiene
risk of pressure sores
How to manage spasticity?
Intramuscular Botox,
Pillow splinting,
splinting in general.
Why should be SOOB?
Maintains joint ROM,
Postural control,
Prevent contractures
Better QoL,
Improves bladder and bowel,
Better oxygenation,
improve awareness.
What is the top 3 in treating?
24 hour posture management,
Assessment of awareness,
Respiratory management.
