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TBI flashcards > TBI flashcards > Flashcards

TBI flashcards

1
Q

Patients with ___ and ___ have been associated with doubling mortality

A

hypotension and hypoxia

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2
Q

what medication used for intubation does not increase ICP?

A

ketamine

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3
Q

what is hyperventilation used for in acute management of TBI

A

decrease ICP through hypocarbic vasoconstriction

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4
Q

when is surgical intervention appropriate for EDH?

A

EDH >30cm or GCS <9, clot thickness >15mm, midline shift >5mm or focal Neuro deficits

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5
Q

when is surgical intervention appropriate for SDH?

A

SDH >10mm or those associated with midline shift >5mm, GCS <8 with rapid decline or ICP <20mmHg

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6
Q

what positional changes can you do to help with intracranial hypertension

A

HOB >30 or reverse trendelenberg position to decrease ICP

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7
Q

when should ICP monitoring be used

A

patients with Severe TBI and abnormal CT scan to reduce 2-week and in-hospital mortality

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8
Q

what fluids are used to reduce ICP?

A

hypertonic saline 3% and mannitol 20%

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9
Q

what study indicated that corticosteroids should not be used in TBI?

A

CRASH trial

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10
Q

what is the equation for CPP

A

MAP - ICP

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11
Q

what are the secondary brain Injuries?

A

impaired CBF regulation and alteration in brain metabolism

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12
Q

what are the goals for ICP and CPP after Brain injury

A

ICP: <20

CPP between 50-70

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13
Q

what are the primary brain injuries?

A

DAI and cerebral contusion

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14
Q

where does DAI typically occur

A

axons of brainstem, parasagittal white matter of cerebral cortex, corpus callous and gray-white matter junctions of cerebral cortex

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15
Q

how do you classify DAI?

A

Adams classification

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16
Q

what is the most common cause of persistent coma after TBI?

A

DAI

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17
Q

what aphasia is not fluent, cannot comprehend and can repeat?

A

mixed transcortical

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18
Q

what aphasia is not fluent, can comprehend but cannot repeat

A

brocas

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19
Q

what aphasia is not fluent, can comprehend and can repeat

A

transcortical motor

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20
Q

what aphasia is fluent, cannot comprehend and can repeat

A

transcortical sensory

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21
Q

what aphasia is fluent, can comprehend but cannot repeat

A

conduction

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22
Q

most common abnormal hormone after brain injury?

A

growth hormone

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23
Q

how do you treat SIADH

A

fluid restriction and if moderate/severe= demeclocycline

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24
Q

most common cause of hypernatremia after brain injury?

A

Diabetes insipidus

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25
Q

how do you treat diabetes insipidus

A

free water replacement and more severe DDAVP

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26
Q

what are the Rancho levels (1-8)

A

1: no response
2. generalized response
3. localized response
4. confused agitated
5. confused inappropriate
6. confused-appropriate
7. automatic-appopriate
8. purposeful-appropriate

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27
Q

what are the levels of the agitated behavior scale

A

14-21: normal
22-28: mild
29-35: moderate
35+ severe

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28
Q

what score on CRSR means minimally conscious state

A

12 or higher

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29
Q

most common site for TBI

A

anterior inferior frontal and temporal lobes

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30
Q

most common brain tumor in childrens

A

astrocytomas and medulloblastomas

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31
Q

most common brain tumor in adults

A

metastatic

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32
Q

most common primary brain tumor in adults

A

GBM

33
Q

what is the clinical presentation of supratentorial tumors

A

seizures, increased ICP and focal neurological deficits

34
Q

what is the clinical presentation of infratentorial brain tumors

A

increased ICP, cranial nerve deficits and ataxia

35
Q

what cancer is the most common to metastasize to the brain

A

small cell lung cancer

36
Q

what is the second most common primary CNS neoplasm

A

meningioma

37
Q

what is the most common intratentorial tumor in adults

A

acoustic neuroma/schwannoma

38
Q

when does focal cerebral radiation necrosis typically occur

A

15-18 mints after XRT

39
Q

when does diffuse cerebral radiation injury occur

A

6-18 months after XRT

40
Q

what scale attempts to quantify outcome in quality of life in individuals with brain tumors

A

Karnofsky scale

41
Q

what variables are related to good quality of life in individuals with Brain tumors

A

freedom from depression, active social life, greater energy, fewer symptoms

42
Q

what complication of radiation for brain tumors is indistinguishable from recurrence of tumor on imaging and requires pathology for confirmation

A

FCRN

43
Q

what is the incidence of HO after TBI

A

11-35%

44
Q

what is the incidence of HO after SCI

A

16-53%

45
Q

what is the incidence of HO after burns

A

0.1-3.1%

46
Q

what is the peak occurrence for HO

A

2 months

47
Q

where is HO most common with SCI

A

hip

48
Q

where is HO most common in burn victims

A

elbow

49
Q

why is indomethacin used in HO

A

inhibits prostaglandin synthetase; inhibits inflammatory response and suppresses mesenchymal cell proliferation

50
Q

what are the gradings for HO around the him

A

0- no heterotopic bone
1- occupies less than 50% of the distance between femur and pelvis
2-occupies >50% of, but not bridging, the distance between the femur and the pelvis
3- formation of bridging heterotopic bone

51
Q

surgical timing for HO

A

traumatic HO can be resected at 6 months
SCI HO at 1 year
TBI HO at 1.5 years

52
Q

what is the major cause of post-TBI NPH

A

SAH

53
Q

what is the most important acute predictor of TBI outcome

A

ICP

54
Q

what are the cutoffs for ICP for not good vs fatal

A

> 40 is not good

>60 is fatal

55
Q

what things make someone more prone to developing both NPH and seizures

A

SAH, depressed skull fracture, meningitis

56
Q

what is the most common cause of TBI in the USA

A

falls

57
Q

what is the most common cause of TBI world-wide

A

MVCs

58
Q

what age demographics are most likely to develop TBi

A

15-19 yo, >75 yo (falls) and 0-4yo

59
Q

where is CSF produced

A

at the choroid plexus in the lateral ventricles

60
Q

what is the most common cause of communicating NPH

A

TBI

61
Q

what are the CT findings for post-traumatic hydrocephalus

A

distended appearance of anterior horns of the lateral ventricles
enlargement of the temporal horns of the 3rd ventricles
normal or absent sulci
enlargement of the basal cisterns or 4th ventricles
periventricular lucency

62
Q

lifetime incidence of TBI is ____ greater in alcoholics

A

4x

63
Q

what percentage of TBIs occurred while the person was drunk

A

~50%

64
Q

how much more likely are TBI survivors to have another TBI

A

3-8 times higher risk

65
Q

how common is depression within the first year of a TBI

A

8 times more common

66
Q

what are the CAGE screening questions

A

C- cut back
A-annoyed
G-guilty
E-eye-opener

67
Q

what are the most significant prognostic indicators after TBI

A

PTA duration and age

68
Q

how do you know if someone is out of PTA

A

GOAT >75 for 2 consecutive days or

O-log 25+ for 2 straight days

69
Q

what are the areas of scoring for CRSR

A

auditory (0-4), visual (0-5), motor (0-6), promoter (0-3), communication (0-2), arousal (0-3)

70
Q

coma lasting longer than ____ is very unlikely to have good outcome

A

2 weeks

71
Q

PTA less than ____ usually has good outcome

A

<2 weeks

72
Q

define coma

A

deep sustained pathologic unresponsiveness in which eyes remain closed and the patient cannot be aroused

73
Q

define vegetative state

A

condition in which awareness of self and environment is presumed to be absent and there is an inability to interact with others, although the capacity for spontaneous or stimulus-induced arousal (wakefulness) is preserved

74
Q

when does vegetative state become persistent

A

after 1 month

75
Q

mechanism of amantadine (most supported)

A

weak, non-competitive antagonist of the NMDA receptor, which increases dopamine release and prevents dopamine reuptake

76
Q

what is the primary thing found in SIADH

A

low sodium

77
Q

diagnostic labs for SIADH

A

low sodium, low serum. osmolarity, urine osmolarity> serum osmolarity, high urine sodium

78
Q

what happens with rapid correction of low sodium

A

central pontine myelinosis

79
Q

what is the primary symptom of DI

A

elevated sodium

TBI flashcards (1 decks)

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