TBI Intro: Secondary Complications Flashcards
paroxysmal autonomic instability and dystonia (PAID)
- “sympathetic storming”
- severe medical instability
- everything is heightened
- episodes unprovoked, last for hours or end abruptly
clinical S&S of PAID
- tachypnea
- tachycardia
- HTN
- diaphoresis
- decorticate/decerebate posturing
- agitation
how do you diagnosis PAID
thru observation
management for PAID
- symptom management (morphine, fentanyl)
- “ride out the storm”
without appropriate treatment for PAID what happens
increased morbidity
heterotopic ossification
formation of abnormal bone growth around joint tissue
how many cases of TBI experience heterotopic ossification and what increases the risk
- 10-20%
- increased risk if TBI polytrauma injury results in fx near joint lines
what is heterotopic ossification most common in
large joints of the body
hips, knees, shoulders, elbows
what is the cause of heterotopic ossification
unknown, associated with trauma, immobility and hypertonicity
onset of heterotopic ossification
4-12 weeks after injury
clinical presentation of heterotopic ossification
- initial signs are loss of ROM (HARD END FEEL) and pain in the joint area
- local erythmea, pain with movement, swelling, warm to touch
- severe HO may result in vascular and/or nerve compression
treatment for HO
- PROM and stretching –> maintaining
- medications
- surgical excision
what medications help with HO
- didronel: preventative
- anti-inflammatory
when do u get a surgical excision following HO
> 1.5 yr after injury
want the bone to mature & finish growing before removal
what other complications are secondary to TBI
- GI (50%)
- genitourinary (45%)
- respiratory (34%)
- CV (32%)
- dermatological (21%)
- urinary bowel incontinence
- hydrocephalus
what clinical manifestations are associated with TBI
- altered level of consciousness/impaired arousal
- cognitive and behavioral impairments
- neuromuscular impairments
- autonomic dysfunction
- sensory abnormalities
- CN damage
- vestibular deficits
- secondary complications
secondary complications
ICP management
seizure reduction or prophylaxis
what can increased ICP lead to
can compress brain tissue
decrease perfusion to brain tissues
normal ICP
5-10 mm Hg
abnormal ICP
20 mm Hg caution @ 15
activities that increase ICP
full supine or trendelenburg cervical flexion percussion & vibration valsalva - coughing, sneezing, holding breath, etc. exertional activities
S&S increased ICP
decreased responsiveness impaired consciousness severe HA vomiting irritability papilledema increased d BP decreased HR
treatment for increased ICP
careful monitoring
pharmacological agents
ventricular peritoneal shunting
if permanent correction is needed
when can PT treat after a seizure
24 hrs seizure free
events that trigger seizures
stress poor nutrition electrolyte imbalance missed mediations or drug use flickering lights infxn anxiety mobility
common S&S for seizures
focal or diffuse twitching, jerking, stiffness
+/- loss of consciousness
absent staring
interventions for seizures
continuous electroencephalogram
medications
