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Neuro I > TBI Intro > Flashcards

TBI Intro Flashcards

1
Q

Patient population of typical TBI

A
  • Children and older adults (>75 YO)
  • Males > females
  • Race: American Indian/Alaskan Native, Black, Hispanic population
  • Service members/veterans
  • Homeless
  • Incarcerated
  • Domestic abuse survivors
  • Rural area dwellings
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2
Q

The MOST common cause of TBI?

A

FALLS
(MVA/MVC, acts of violence and sports)

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3
Q

Children will most likely suffer a TBI due to:

A

fall, abuse

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4
Q

Adolescents & young adults will most likely suffer a TBI due to:

A

falls, assault, MVA

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5
Q

Open TBI

A

penetrating wound, skull fracture, meningeal compromise

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6
Q

Closed TBI

A

no skull fracture, only cortical tissue, meninges remain intact

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7
Q

Focal injury

A

localized to area under site of impact or site opposite to site of impact.

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8
Q

Types of Focal TBIs

A
  1. Hematomas
  2. Hemorrhage
  3. Contusion
  4. Coup-contrecoup injuries
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9
Q

Common sites of focal injuries.

A

Anterior-inferior temporal lobes, prefrontal lobes

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10
Q

Which type of TBI often have stroke-like presentation.

A

Focal TBI

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11
Q

Your patient was struck in the head and had a brief syncope episode then regained consciousness. Later on they suddenly went unconscious. What type or TBI are you suspecting and what is the potential treatment?

A

Epidural hematoma, craniotomies and hematoma evacuation

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12
Q

Your elderly patient fell and hit their head. EMS was called and the patient refused transport. They did not loose consciousness. Now it is the next morning and they are not waking up. What kind of TBI do you expect they have and what is the treatment?

A

subdural hematoma, smaller clots will be reabsorbed by the body, larger clots will require surgical removal.

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13
Q

What is the most life threatening type of TBI and a common sequela?

A

Subarachnoid hemorrhage (SAH), vasospasm

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14
Q

A common sequela of intracerebral hemorrhage includes

A

seizures

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15
Q

Coup lesion

A

contusion on the same size of the brain as the impact.

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16
Q

Contrecoup lesion

A

surface hemorrhages on the opposite side of the brain trauma as a result of deceleration

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17
Q

Which is associated with more damage, coup or countercoup damage?

A

Contrecoup

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18
Q

Most common structures involved with coup-contrecoup injuries include:

A

anterior poles, underside of temporal and frontal lobes

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19
Q

A diffuse axonal injury is:

A

widespread shearing and retraction of damaged axons resulting in traumatic micro-bleeds

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20
Q

Diffuse axonal injury are associated with significant neurological involvement and a poor prognosis. They most commonly result from damage where?

A

corpus callosum
basal ganglia
brainstem
cerebellum

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21
Q

T/F secondary brain damage post-TBI occurs much like a stroke via apoptosis and/or necrosis.

A

False, TBI secondary damage only occurs through apoptosis

22
Q

Why is increased ICP more dangerous when associated with secondary brain damage compared to primary?

A

Associated with higher rates of herniation and death

23
Q

The areas most vulnerable to anoxic/hypoxic brain injuries include

A

-Hippocampus
-Cerebellum
-Basal Ganglia

23
Q

Primary cause of anoxic or hypoxic brain injuries?

A

cardiac arrest (also, CO2, toxicity, near drowning, severe bleeding = systemic hypotension)

24
Q

Primary blast injuries

A

direct effect of blast overpressure on organs

25
Q

What type of blast injury results in diffuse brain damage?

A

primary

26
Q

Secondary and Tertiary blast injuries are characterized by:

A

2ND: shrapnel
3RD: direct blow to head

27
Q

Imaging in the acute management stage of a TBI consists of:

A

MRI/CT, PET, EEG

28
Q

Acute medical management of TBI includes

A

↓ BP/ICP/IC bleeding/body temp/infection rate/seizure risk

29
Q

If a patient is in induced hypothermia to decrease ICP, are they a candidate for PT?

A

NO

30
Q

The primary acute TBI concern

A

Increased ICP

31
Q

Abnormal ICP Value

A

≥20 mmHg (NOT PT CANDIDATE)

32
Q

Your pt ICP has been steady around 15 mmHg. Are they a candidate for PT?

A

Yes, but proceed carefully avoiding interventions that increase ICP.

33
Q

Activities that increase ICP

A
  • Percussion + vibration
  • Fully supine or Trendelenburg
  • Cervical flexion
  • Valsalva
  • Exertional activities (quick elevation HOB, supine>sit)
34
Q

S&S of ICP

A

↓ responsiveness
↓ consciousness
- Seizures
- Severe HA
- Vomiting
- Irritability
- Papilledema, pupillary changes, impaired eye movement
- Speech changes
- Posturing
*Cushing’s Triad: ↑ BP/↓ HR, irregular RR

35
Q

Treatment of ICP

A

Careful monitoring
Pharmacological agents
Ventricular peritoneal shunt

36
Q

When can you mobilize a patient who has post-TBI seizures?
a. ≥24 hours seizure free
b. 24-48 hours seizure free
c. ≥ 72 hours seizure free
d. 24-72 hours seizure free

A

a. ≥24 hours seizure free

37
Q

Common S&S of seizure

A
  • focal/diffuse twitching, jerking, stiffening
    -potential LOC
    -Absent staring, “zoned out”
38
Q

Paroxysmal Autonomic Instability and Dystonia (PAID)

A

severe medical instability, overdrive of nervous system (“Sympathetic Storming”)

39
Q

GCS associated with PAID

A

3-8

40
Q

Medical management of PAID

A

Symptom management (CNS depressant meds) “ride the storm out”

41
Q

Patients are at an increased morbidity risk with PAID…

A

w/o management/appropriate treatment

42
Q

S&S Paid:

A

Tachypnea
Tachycardia
Fever (hyperthermia)
HTN
Diaphoresis
Rigidity +/- decorticate posturing / *decerebrate posturing
Agitation

43
Q

How do symptoms of PAID present

A

Cyclicly, at least one cycle/day ~3h long

44
Q

T/F Decorticate posturing is associated with PAID syndrome d/t damage above red nucleus

A

False, decerebriate posturing is associated with the sympathetic involvement lower in the brainstem.

45
Q

What posturing is associated with damage in relation to the red nucleus

A

Above: decorticate
Below: decerebrate

46
Q

Polytrauma TBI patient’s have an increased risk of

A

Heterotopic ossification most common in large joints

47
Q

It is 8 weeks post-TBI for your patient. They also suffered from multiple fractures d/t an MVC. They are now complaining of knee pain and decreased ROM. You also note erythema, pain with movement, selling and warmth. When you are assessing how will you differentiate between a DVT and HO?

A

End feel! (DVT: empty or normal end feel, HO: hard end feel)

48
Q

HO PT Treatment

A

PROM and stretching to maintain ROM and prevent further complications.

49
Q
A

Neuro I (7 decks)

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