TBI and Spinal Cord Injuries Flashcards
1
Q
Monro-Kellie theory
A
when the volume of one component of ICP goes up, the others must go down
2
Q
what is the easiest component of ICP to displace
A
CSF
3
Q
second easiest thing to displace in ICP
A
blood volume
4
Q
MAP formula
A
(SBP+2(DBP))/3
5
Q
CPP
A
MAP-ICP
6
Q
approximate cerebral blood flow
A
50 mL/min/100g
7
Q
most common cause of cerebral edema
A
vasogenic
8
Q
where does vasogenic cerebral edema mostly occur
A
mainly in white matter
9
Q
s/s of vasogenic cerebral edema
A
range from HA to coma
10
Q
what is cytotoxic edema
A
disruption of the integrity of the cell membranes
11
Q
what does cytotoxic edema lead to
A
inappropriate ADH secreiton
12
Q
what causes interstitial edema
A
usually a result of hydrocephaly
13
Q
where do VS changes in cushing’s triad come from
A
changes in pressure at the thalamus, hypothalamus, ons and medulle
14
Q
how to treat increased ICP X3
A
head midline and elevated 30 degrees
cluster care
low stimulation
15
Q
care of ICP monitors X6
A
minimize infection risk
label tubing
keep dressing clean/dry
keep off floor
do not give meds
don’t allow d/c
16
Q
drugs used in IICP X2
A
corticosteroids - dexamethasone
hypertonic saline
17
Q
what is a head injury
A
any trauma to scalp, skull, brain
18
Q
what is head trauma
A
includes an alteration in consciousness - no matter how brief
19
Q
highest risk of head injury
A
males 15-24, then little kids, then old people
20
Q
when is death likely in a head injury
A
immediately after the injury
within 2 hours after injury
3 weeks after injury
21
Q
why does death occur immediately after a head injury
A
catastrophic injury
22
Q
why does death occur 2 hours after head injury
A
bleeding out
swelling out of control
23
Q
why doesdeath occur 3 weeks after a head injury
A
3 weeks after injury
24
Q
what is the primary head injury
A
the actual damage
25
what is the secondary head injury
what occurs in the coming days
26
key characteristic in scalp lacs
bleed profusely but heal quickly
27
how do you know if a skull fracture is open
feel for mushy spots
28
s/s of basilar skull fractures
ear/nose bleeding
leaking straw colored CSF
29
CI in basilar fractures
no NG tube
30
CI in any injury with a CSF leak
do not do anything that would introduce bacteria
31
concussion s/s X2
brief disruption in the level of consciousness
retrograde amnesia
32
what happens with repeat concussions
may make future concussions worse
33
what is a diffuse axonal injury
widespread sheared axonal damage that occurs primarily in the white matter after any brain injury
34
axonal injury presentation
will arrive unconscious with a blank initial CT
repeat CT shows small bleeds in parenchyma
35
diffuse axonal injury interventions
head elevated
comfort
midline
clustur care
36
CI in diffuse axonal injury
no surgery
37
prognosis for diffuse axonal injury
if they don't improve within 24 hours they probably wont
38
x3 focal injuries
brain lacerations
contusions
coup-contrecoup
39
DAI s/s X4
decreased LOC
IICP
decerebration or decortication
global cerebral edema
40
what is an epidural hematoma
bleeding between dura and inner surface of the skull
bleeding from middle meningeal artery
hemorrhage in epidural space
41
s/s of epidural hematoma X4
initial period of unconsciousness
brief lucid interval
decrease in LOC
HA, N/V
42
epidural hematoma nickanme
walking dead - go straight to OR
43
acute subdrual hematoma s/s
similar s/s to brain tissue compression in IICP
44
when do acute SDH's occur
within 24-48 hours
45
what is a subacute SDH
the SDH may appear to enlarge overtime after the initial bleeding
46
when do subacute SDH's occur
within 2-14 days
47
what kind of bleed is a acute SDH
arterial bleed
48
what kind of bleed is a subacute SDH
venous bleed
49
chronic SDH s/s X4
increased ICP
N/V
vomiting w/o nausea
decreased LOC
50
peak incidence in chronic SDH
sixth and seventh decades of life
51
who is most likely to have a chronic SDH
alcoholics d/t chronic falling
52
are chronic SDH's emergent
no - probably will not require OR
53
what is a intracerebral hematoma
occurs from bleeding within the parenchyma usually between the frontal and temporal lobes
54
what determines outcome in an intracerebral hematoma
size and location
55
tx of intracerebral hematoma
cannot be removed - must wait to heal
tx s/s
56
common causes of SAH X3
SA aneurysm, head trauma, HTN
57
s/s of SAH X3
sudden severe HA often confused with migraine
photophobia
nuchal rigidity
58
what happens 3-14 days after a SAH
clot lyses and gets reabsorbed
59
how do you prevent vasospasm in SAH
use Nimodipine (Ca Channel blocker)
60
where do CN I and II occur
above the medulla and are hard to assess in an unconscious patient
61
how long does cell death continue after spinal cord injuries
weeks or months
62
why does permanent injury occur in spinal cord injuries around 24 hours
edema
63
what is spinal shock
temporary neurologic syndrome
concussion of the spinal cord that resolves as soft tissue swelling goes away
64
how long does spinal shock last
hours to weeks
65
spinal shock s/s
flaccid areflexia
warm and dry
66
neurogenic shock
loss of vasomotor tone - true shock
67
how does neurogenic shock resolve
usually on its own
68
when should you assume it's neurogenic shock
if they don't respond to fluid - then give pressors
69
causes of neurogenic shock X4
GB syndrome
spinal anesthesia
ANS toxins
Down's Kids
70
s/s of neurogenic shock
loss of sympathetic tone to heart and vascular system
deadly triad
71
deadly triad in neurogenic shock
hypotension
bradycardia
peripheral vasal dilation
72
what causes hyperflexion
sudden forward motion
73
what does starring the windshield mean
hitting the windshield with forehead
74
most mobile section of spine
C5-6
75
hyperextension
head accelerates and rapidly decelerates
vertebrae might fracture/subluxate
76
axial loading
vertical force results in vertebral shatter - diving accident
77
safest thing to do in combative axial loading pts
medicate and intubate
78
rotational injury
displacement of the spinal column
79
skeletal level of injury
at the vertebral level
most damage to vertebral bones and ligaments
80
neurological level of injury
lowest segment of spinal cord with normal sensory and motor function on both sides of the body
81
what occurs if the thoracic or lumbar cord is damaged
paraplegia
82
when are arms rarely damaged in spinal cord injuries
high C damage
83
what happens in high atlas fractures
death likely - internal decapitation
84
complete cord involvement
results in total loss of sensory and motor function below level of lesion
85
incomplete/partial cord involvement
mixed loss of voluntary motor activity and sensation and leaves some tracts intact
86
central cord syndrome
damage to the scentral spinal cord
87
where do central cord syndrome injuries commonly occur
commonly in the cervical region in older adults
88
s/s of central cord syndrom
motor weakness and sensory loss in all limbs but worse in arms than in legs
89
anterior cord syndrome
caused by damage to anterior spinal artery leading to compromised blood flow
90
what causes anterior cord syndrome
injuries causing acute compression of anterior portion of spinal cord
91
brown sequard syndrome
result of damage to one half of the spinal cord
92
brown sequard syndrome s/s X3
loss of motor function and position and vibration sense on same side of injury
paralysis on same side as injury
opposite side has loss of pain and temp sensation below level of lesion
93
respiratory complications with a C3 and above injury
near total ventilatory muscle paralysis
artificial airways provide direct access for pathogens
94
respiratory complications for a C3-C5 injury
loss of phrenic nerve function
95
respiratory complication for C6-T8
loss of phrenic nerve and intercostals
96
respiratory complications for T7-T12 injury
loss of abdominal muslces
97
cardiovascular implications and tx for a T6 and up injury
sympathetic nervous system is reduced
heart rate is slowed
IV fluids
SCD's, lovenox, TCDB
98
urinary system implicatoins during spinal cord injuries
urinary retention and hyperirritability common
99
GI system implicatoins T5+
primary issue is hypomotility
100
GI issues T12 down
decreased sphincter tone
101
autonomic dysreflexia X4
HTN
blurred vision
throbbing headache
marked diaphoresis above lesion level
102
autonomic dysreflexia NI
elevate HOB at 45 degrees+
assess cause (bladder fullness)
notify physician
immediate catheterization
