TBI Management Flashcards
What is rehab medicine?
The process of helping a person reach the fullest physical/psychological/social/vocational/ educational potential consistent with anatomic or physiological impairment, environmental limitations and desires and life plans.
The process of active change by which a patient acquires knowledge and skills necessary for optimal physical, psychological and social function.
What types of acquired brain injury can you have?
Acquired – post birth: TBI - an alteration in brain function, or other evidence of brain pathology, caused by an external force Haemorrhagic Vascular Anoxic Infective
What is the epidemiology of TBI?
1 million pts in the UK attend hospital/year (2000/105) – very common, most mild injury
½ are under 16yrs
275/105 are admitted to hospital per yr.
Moderate-severe head injury in 25/105/per yr
10-20% likely to have some long-term disability
What is the aetiology of TBI?
Increasingly falls is becoming the commonest cause of TBI because of aging population
Sport 10-20%
RTC 25-30%
Assaults – 9-10%
Describe a contrecoup injury
Injury from brain moving and hitting the front/back of skull – TBI results in more behavioural adjustments as affects frontal lobe
What are diffuse axonal injuries?
When dendrite meets axon Severe rotation or deceleration force e.g. RTC Often LOC Not much blood Worse prognostic signs Only 20% seen on CT, better on MRI
What are the secondary injuries that might be aquired from TBI?
Altered cerebral blood flow- autoregulation
Hypotension (relationship to ICP and CPP)
Herniation
Hydrocephalus
Release of neurotoxic compounds
cellular inflammatory response
cytokines
calcium influx
oxygen free radicals
One episode hypotension can increase mortality by 50%
What is the max GCS score if intubated?
11
What is heterotopic ossification?
Bone formation in wrong places
Shock to cells causes osteoblast differentiation and production of bone
What is the aim of long term rehab?
Functional gains to achieve independent living
Vocational rehabilitation- return to work or alternative employment.
Addressing emotional and psychological issues
Importance of individual wishes
What is the glasgow outcome scale?
Assessment of outcome post TBI - its very difficult to score upper good recovery
What are some risk factors for ongoing symptoms?
Previous brain injury Female Education level Past psychiatric history Genetics? APOE4
What are some perpetuating factors for TBI poor recovery?
Alcohol Drugs Depression Lack of support Money – litigation (rarely)
What did the SHEFBIT study look at and find?
Looked at work, depression and Rivermead Scores after TBI (mostly mTBI) 1 Year on: 23.8% no work 27.5% less work 43.9% same work as before TBI 41% depression 43% anxiety High Rivemead scores
