TBI (Doms lecture) Flashcards

1
Q

traumatic brain injury (TBI)

A

when a sudden external, physical assault damages the brain
~ 1.4 million treated in ED each year
27,000 are hospitalized
52,000 die from their injury

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2
Q

most common causes of TBI

A

adolescence and young adults: motor vehicle collisions
adults/older: falls

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3
Q

2 primary types of TBI

A

closed BI
penetrating BI

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4
Q

closed BI

A

non-penetrating injury to the brain with no break in the skull
can result from rapid forward and backwards movement of the brain in skull = tearing and bruising the brain tissues and blood vessels
coup contrecoup
diffuse axonal injury

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5
Q

coup contrecoup

A

coup = point of impact
contrecoup = injury of opposite side

when the brains goes back and forth in the skull hitting the front and back point of impact

ex) bang head against a walk and the brain goes forward hitting front of skull and then back hitting back of skull

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6
Q

diffuse axonal injury

A

tearing of the brain’s long connecting nerve fibers (axons) that happen when the brain is injured as it shifts and rotates inside the skull
damage to:
white matter
changes can be microscopic
can lead to disordered consciousness
difficult to see on a CT or MRI
can occur without other visible damage

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7
Q

penetrating BI

A

open head injuries where there is a break in the skull

results from:
objects penetrating and skull bone fragments damaging brain tissue and blood vessels = deprivation of normal blood supply (ischemia) OR accumulation of blood (hemorrhage)
cognitive impairment tends to be more focal

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8
Q

chronic traumatic encephalopathy (CTE)

A

produces neurodegeneration due to repeated head trauma
prevalence in athletes who participate in contact sports and experience frequent and repeated head trauma
can only be confirmed postmortem

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9
Q

confirmation of CTE postmortem

A

abnormal tau protein accumulation (similar to alzheimer’s)
reduced brain volume (corpus callosum and limbic system)
ventricular enlargement

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10
Q

characteristic deficits in CTE

A

mood and cognitive impairment can appear years after injury occurred
dysexecutive functioning and mood lability

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11
Q

other mechanisms of injury (primary injury and secondary injury)

A

primary injury happens first: skull lacerations, skull fractures, contusions cerebral lacerations, intracranial hemorrhage, diffuse axonal injury)

time goes on (seconds/minutes/days)

secondary injury due to: increased intracranial pressure, hypoxia, hypotension, hypertension, electrolyte disturbance, toxic amino acid, oxygen radicals

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12
Q

recovery process

A

one will lose a period of time from before injury

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13
Q

post-traumatic amnesia

A

state of confusion and disorientation that occurs immediately after TBI; part of the healing process; brain is unable to form continuous day to day memories

can be very difficult for family members = always provide resources and education
goal = support reorientation and sense of safety

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14
Q

classification system for TBI

A

uses duration of unconsciousness; Glasgow Coma Scale; and PTA; doesnt alway line up perfectly; someone can fall in the mild range for duration of unconsciousness and in the moderate range for Glasgow Coma Scale

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15
Q

Glasgow Coma Scale

A

done on site by EMT or in ED; used to get severity of injury; looks at eye opening, best motor response, and verbal response

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16
Q

Limitation os Glasgow Coma scale

A

substance use
administered drugs
intubation (cant talk or respond)
Injury to eye (cant do eye opening test)
Hemiplegia (cant do motor response)
language (verbal response)

17
Q

behavioral presentation of PTA

A

confused and disoriented
agitation and aggression
inability to recognize loved ones
childlike clingy behavior
confabulation

18
Q

for PTA you should never…

A

ask them to recall the injury.. they cannot do it

19
Q

Rancho Los Amigos Scale -Revised (RLAS-R)

A

a scale used to describe behavioral and cognitive patterns found post TBI

20
Q

Dose response relationship

A

for mild TBI cognitive changes resolve within weeks-~3 months at most

changes tend to persist >2 years following moderate-severe TBI

21
Q

non-injury risk factors that influence TBI outcomes

A

pre-injury psychiatric status and conduct issues/incarceration (hyperfocus on cog issues)
age at injury (older you are the slower you recover)
level of education
stable employment 6 months pre-injury (best predictor of return to employment post-injury)
marital status (perceived social support)
other non-neurological injuries sustained (physical injuries can prevent return to meaningful activities)

22
Q

FBS

A

symptom validity scale; non-credible somatic and cognitive complaints

23
Q

RBS

A

response bias scale; exaggerated memory complaints

24
Q

post concussion syndrome: conscious attempt

A

2 types:
Primary gain (goal is internal; for medical attention or sympathy)
secondary gain (goal is external; day off at work or extra compensation)

25
Q

primary gain: fictitious disorder

A

Munchausen syndrome (imposed on self)
Munchausen by Proxy (imposed on another usually child or elderly patient)

26
Q

Post concussion syndrome vs somatization: unconscious attempt

A

somatic symptoms and related disorders;
somatic symptom disorder
conversion disorder
illness anxiety disorder