TBI and Spinal cord Injuries Flashcards
TBI
7 million per year, motor vehicle accidents, sports, violence
people greatest at risk OA (falls), males of all ages, adolescents 15-19
Scalp Injury
avulsion, laceration (infection and bleeding)
Concussion
temporary loss of neuro function, no structural brain damage
blunt trauma- contact sports, etc- 80% of TBIs
Open TBI
fractured/ perforated skull
Closed TBI
blunt trauma, skull is intact
Concussion symptoms
headaches, nausea, fatigue, photophobia, sound sensitivity, foggy sensation (improves with rest)
Concussion red flags
decrease in LOC, worsening headache, irritability, seizures, slurred speech, pupillary changes, numbness/ weakness in arms/ legs
Concussion- monitoring
headache, N/V, photophobia, amnesia, vision and pupil changes
awaken the pt q2h and check for difficulty speaking, confusion, severe headache
Chronic Traumatic Encephalopathy (CTE)
repeated concussions, degenerative brain disease with cerebral atrophy- found in athletes
similar to alzheimers- personality changes, memory impairments, speech and gait disturbances, Tau protein destroys brain cells
Types of skull fractures
Simple (hairline), comminuted (splintered, compound), depressed (embeds in brain tissue), basilar (base of skull)
Diagnosis of Skull fractures
CT/MRI
Symptoms of a skull fracture
localized pain, headache, bleeding/ drainage from nose/ ears (may cause meningitis), battle’s sign (ecchymosis at mastoid), raccoon eyes
If CSF leak is suspected in the nose, what is contraindicated?
NG tube, nose suctioning, NOTHING in the nose
Dextrostix
diagnostic for CSF, determines if sugar is present in fluid
Halo Sign
if you allow leaking fluid to drip on a gauze pad, if the blood coalesces to the center and a yellow ring encircles the blood, the ring is CSF
Cerebral contusion
more common in frontal and temporal, may cause altered LOC, cerebral edema, cerebral hemorrhage, elevated ICP
Coup
contusion found at the site of impact
Contrecoup
location opposite the site of impact
Subdural hematoma
venous bleeding between dura and brain, acute or chronic, occurs slowly
craniotomy/ burr holes
evacuates clot, controls bleeding and decreases ICP- used for subdural and epidural
Epidural hematoma
arterial, emergent, blood collects between skull and dura
drain may be inserted to prevent blood accumulation
Intracerebral hematoma
bleeding w/in the brain tissue, causes edema and increased ICP
Causes of intracerebral hematoma
traumatic injury, uncontrolled HTN, hemorrhagic CVA (MVA, cerebral aneurysm), tumors, anticoagulant meds complication
Treatment of TBI
proper positioning, medications (mannitol, corticosteroids), ventilation, oxygen, management of pain and anxiety (propofol), quiet environment, decreased stimulations, no restraints
Surgical interventions for TBI
burr holes- emergency, debridement and elevation of depressed bone
SCI risk factors
younger age (16-30), male gender (80%), alcohol and drug use, MVA is primary, diving is primary for sport
severity and manifestations of sci are determined by what
mechanism of injury, level of cord injury, type of lesion
Mechanism of injury
hyperflexion, hyperextension, compression, displacement, penetration
Vertebrae most often involved in lesions
C5-7, T12, L1
Complete Lesion
loss of sensory and motor function, occurs below level of lesion (paraplegia/ quadraplegia)
Incomplete Lesion
communication is not completely lost, some ability to relay messages to/from brain
Tetraplegia
injury at or above C8
Paraplegia
injury at or below T1
C1, 2, 3 injury
inability to control muscles or breathing (no diaphragm control, continuous ventilatory support essential, unable to care for self, requires 24hr supervision
C4 injury
will have head/ neck sensation and motor function, no upper extremity muscle function- can raise shoulders, minimal respiratory capacity, unable to feed self
C5 injury
good head and neck control, can raise arms and bend elbows, may have paralysis of wrists and hands, can typically breathe on own but resp effort may be weakened, may be able to operate electric wheelchair and feed self, little or no voluntary control of bladder/ bowel
C6 injury
partial strength of pec major, has wrist extension, may have paralysis of the hands, may be able to self propel in light weight wheelchair, can transfer self to wheelchair, may be able to drive adaptive vehicle, can feed self with devices, may be able to write, little/ no voluntary control of bladder/bowel
C7 injury
needs wheelchair, some finger function, normal shoulder function, can dress lower legs, may be able to drive adaptive car, no b/b control
T1-T5 injury
normal arm and hand motor fuction, can use manual wheelchair and adaptive car, may be able to stand using a standing frame, can use intercostal muscles to breath
T6-T12 injury
normal upper body movement, should be able to cough normally, can use a manual wheelchair and adaptive car, may be able to walk with special braces
ipsilateral paralysis
same side paralysis, motor function, pressure, vibration loss
contralateral paralysis
opposite side paralysis, pain and temp loss
Cauda equina
bundle of nerves that innervate the legs and bladder
SCI: emergency treatment
rapid assessment, immobilization, extrication, resuscitation and stabilization, transport
Spinal shock
affects 50% of SCI patients
SUDDEN LOSS OF REFLEX ACTIVITY…Below level of injury…ARREFLEXIA
Loss of motor & sensory function below level of SCI
caused by inflammation»_space;» restricts blood flow below level of injury
Results in: bradycardia, hypotension
If edema resolves/decreases, pt. may recover reflexes, sensation, and motor
control
(depends on the severity of injury)
May involve respiratory muscles
Affects bowel & bladder reflexes
Lasts hours to months…typically1-6 weeks
Neurogenic shock
Associated with high cord injuries > T5-6
Loss of sympathetic nervous system function below level of
injury
Affects tone in blood vessels
Causes massive peripheral vasodilation
…and venous pooling occurs in lower extremities
Results in: BRADYCARDIA & HYPOTENSION
pt does not perspire
Pulmonary complications
impaired ventilation, impaired respiratory muscles, inability to cough, IS, suctioning, trach care
