TBI and Spinal cord Injuries

Question 1

TBI

Answer 1

7 million per year, motor vehicle accidents, sports, violence

people greatest at risk OA (falls), males of all ages, adolescents 15-19

Question 2

Scalp Injury

Answer 2

avulsion, laceration (infection and bleeding)

Question 3

Concussion

Answer 3

temporary loss of neuro function, no structural brain damage

blunt trauma- contact sports, etc- 80% of TBIs

Question 4

Open TBI

Answer 4

fractured/ perforated skull

Question 5

Closed TBI

Answer 5

blunt trauma, skull is intact

Question 6

Concussion symptoms

Answer 6

headaches, nausea, fatigue, photophobia, sound sensitivity, foggy sensation (improves with rest)

Question 7

Concussion red flags

Answer 7

decrease in LOC, worsening headache, irritability, seizures, slurred speech, pupillary changes, numbness/ weakness in arms/ legs

Question 8

Concussion- monitoring

Answer 8

headache, N/V, photophobia, amnesia, vision and pupil changes

awaken the pt q2h and check for difficulty speaking, confusion, severe headache

Question 9

Chronic Traumatic Encephalopathy (CTE)

Answer 9

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

Question 10

Types of skull fractures

Answer 10

Simple (hairline), comminuted (splintered, compound), depressed (embeds in brain tissue), basilar (base of skull)

Question 11

Diagnosis of Skull fractures

Answer 11

CT/MRI

Question 12

Symptoms of a skull fracture

Answer 12

localized pain, headache, bleeding/ drainage from nose/ ears (may cause meningitis), battle’s sign (ecchymosis at mastoid), raccoon eyes

Question 13

If CSF leak is suspected in the nose, what is contraindicated?

Answer 13

NG tube, nose suctioning, NOTHING in the nose

Question 14

Dextrostix

Answer 14

diagnostic for CSF, determines if sugar is present in fluid

Question 15

Halo Sign

Answer 15

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

Question 16

Cerebral contusion

Answer 16

more common in frontal and temporal, may cause altered LOC, cerebral edema, cerebral hemorrhage, elevated ICP

Question 17

Coup

Answer 17

contusion found at the site of impact

Question 18

Contrecoup

Answer 18

location opposite the site of impact

Question 19

Subdural hematoma

Answer 19

venous bleeding between dura and brain, acute or chronic, occurs slowly

Question 20

craniotomy/ burr holes

Answer 20

evacuates clot, controls bleeding and decreases ICP- used for subdural and epidural

Question 21

Epidural hematoma

Answer 21

arterial, emergent, blood collects between skull and dura

drain may be inserted to prevent blood accumulation

Question 22

Intracerebral hematoma

Answer 22

bleeding w/in the brain tissue, causes edema and increased ICP

Question 23

Causes of intracerebral hematoma

Answer 23

traumatic injury, uncontrolled HTN, hemorrhagic CVA (MVA, cerebral aneurysm), tumors, anticoagulant meds complication

Question 24

Treatment of TBI

Answer 24

proper positioning, medications (mannitol, corticosteroids), ventilation, oxygen, management of pain and anxiety (propofol), quiet environment, decreased stimulations, no restraints

Question 25

Surgical interventions for TBI

Answer 25

burr holes- emergency, debridement and elevation of depressed bone

Question 26

SCI risk factors

Answer 26

younger age (16-30), male gender (80%), alcohol and drug use, MVA is primary, diving is primary for sport

Question 27

severity and manifestations of sci are determined by what

Answer 27

mechanism of injury, level of cord injury, type of lesion

Question 28

Mechanism of injury

Answer 28

hyperflexion, hyperextension, compression, displacement, penetration

Question 29

Vertebrae most often involved in lesions

Answer 29

C5-7, T12, L1

Question 30

Complete Lesion

Answer 30

loss of sensory and motor function, occurs below level of lesion (paraplegia/ quadraplegia)

Question 31

Incomplete Lesion

Answer 31

communication is not completely lost, some ability to relay messages to/from brain

Question 32

Tetraplegia

Answer 32

injury at or above C8

Question 33

Paraplegia

Answer 33

injury at or below T1

Question 34

C1, 2, 3 injury

Answer 34

inability to control muscles or breathing (no diaphragm control, continuous ventilatory support essential, unable to care for self, requires 24hr supervision

Question 35

C4 injury

Answer 35

will have head/ neck sensation and motor function, no upper extremity muscle function- can raise shoulders, minimal respiratory capacity, unable to feed self

Question 36

C5 injury

Answer 36

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

Question 37

C6 injury

Answer 37

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

Question 38

C7 injury

Answer 38

needs wheelchair, some finger function, normal shoulder function, can dress lower legs, may be able to drive adaptive car, no b/b control

Question 39

T1-T5 injury

Answer 39

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

Question 40

T6-T12 injury

Answer 40

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

Question 41

ipsilateral paralysis

Answer 41

same side paralysis, motor function, pressure, vibration loss

Question 42

contralateral paralysis

Answer 42

opposite side paralysis, pain and temp loss

Question 43

Cauda equina

Answer 43

bundle of nerves that innervate the legs and bladder

Question 44

SCI: emergency treatment

Answer 44

rapid assessment, immobilization, extrication, resuscitation and stabilization, transport

Question 45

Spinal shock

Answer 45

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 >>>> 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

Question 46

Neurogenic shock

Answer 46

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

Question 47

Pulmonary complications

Answer 47

impaired ventilation, impaired respiratory muscles, inability to cough, IS, suctioning, trach care