TBI and Shaken Baby Syndrome Flashcards
traumatic brain injury
- an external force either accidentally or intentionally impacts the head
- symptoms vary depending on location/extent of injury
T or F: most children diagnosed with TBI only have mild injury
T: 97%
what is the leading cause of death and disability in children 1-19 years
brain injury
is brain injury more common in boys or girls
boys
what are some risk factors for TBI in pediatrics
- hyperactive
- attention deficits
- impulsivity
- previous TBI
what are some causes of TBI in peds
- falls
- MVA
- abuse/assalt
- gunshot wounds
- sport
acceleration-deceleration injuries
- when a moving head hits a fixed object
- infants are more susceptible
- result in translational and rotational injury
_____ is the initial impact damage while ____ is the deceleration damage
coup
counter-coup
impression injuries
when a solid object impacts a stationary head
what are some examples of primary brain damage from trauma
- concussion
- contusion
- skull fx
- intracranial hemmarrhage
extradural hematomas
- tearing of an artery in the brain
- caused by skull fx or bending of the skull into the brain
subdural hematoma
injury to veins in a subdural space
intracerebral hematoma
trauma or rupture of a congenital vascular abnormality
diffuse axonal injury
- shearing trauma disturbs cellular structures following a rotational injury
- associated with loss of consciousness, extensor rigidity, and autonomic dysfunction
what are some secondary injuries from TBI? which one is the most common
- cerebral edema - most common
- herniation syndromes
- hypoxic ischemic injury
- neurochemical events
what are some other consequences of brain damage
- hydrocephalus
- seizures
- infections
- dysautonomia
- endocrine disorders
T or F: seizures are more common after brain damage in adults than children
F: more common in children
communicating hydrocephalus
cerebral spinal fluid can still flow within ventricles
non-communicating hydrocephalus
obstruction to the flow of CSF within the ventricles
glasgow coma scale
eyes, verbal, motor
lower scores = worse outcome
pediatric coma scale is used in what ages
birth to 5 years
peds GCS eyes
4 - spontaneously
3 - to speech
2 - to pain
1 - none
peds GCS motor
5 - obeys commands
4 - localizes to pain
3 - flexion to pain
2 - extension to pain
1 - none
peds GCS verbal
5 - oriented
4 - localizes to pain
3 - vocal sounds
2 - cries
1 - none
what is the most consistent predictor of outcome in peds TBI
duration of coma
longer duration = worse outcomes
T or F: young children rarely stay in persistent state of coma
T
other than duration of coma, what are other predictors of injury severity/outcomes in peds TBI
- depth of coma (GCS)
- orientation and amnesia assessment
- duration of post-traumatic amnesia
- rancho los amigo score
- age
- function
- environment
children’s orientation and amnesia test (COAT) is used to assess PTA in what ages
4-15 years
greater than ___ weeks of post-traumatic amnesia indicates significant impairment of future memory function
3
a peds rancho scale is used for what ages
birth - 7 years
are younger or older children more vulnerable effect of diffuse brain injury
younger because they have increased plasticity
what are some factors that influence walking ability after TBI in peds
- time in coma
- LE injury
- impaired responsiveness
- LE spasticity
what is the most common cog impairment in children after TBI
memory deficits
- due to damage to temporal lobe
decorticate posturing
UE flexion
LE extension
decerebrate posturing
UE and LE extension
*more severe
ataxia is due to damage in the…
cerebellum and basal ganglia
T or F: all children with TBI should have audiologic evaluation
T
visuospatial skills can be impaired due to damage in the…
temporal or occipital lobes
figure-ground deficit
inability to distinguish a figure from the background
signs of heterotopic ossification
decreased ROM
pain
swelling
erthema
warmth
what are 2 factors that increases the risk of heterotopic ossification in kids
> 11 years
longer coma duration
what 2 fractures are common in peds TBI
pelvic
LE
you should reposition every ____ hours in lying and every _______ minutes in sitting
2
30?
what is the best position when lying after pediatric TBI
side lying
shaken baby syndrome
vigorous manual shaking of an infant who is being help by the extremities or shoulders, leading to whiplash-induced intracranial and intraocular bleeding and no external signs of head trauma
victims of shaken baby syndrome are usually less than ____ year(s) old
1 year old
*most <6months
what 2 injuries are often found in shaken baby syndrome
- intracranial injury
- retinal hemorrhages (typically bilateral)
parental risk factors of shaken baby syndrome
- psychiatric problems
- stress
- unrealistic expectations
- inadequate knowledge of infant development/needs
- substance abuse
- young/immature parents
- poor impulse control
infant risk factors of shaken baby syndrome
- prematurity
- critically/chronically ill
- born drug-addicted
- congenital abnormalities
- physical/developmental delays
- colic/inconsolable crying
