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Neuro Rehab II > TBI (Part 1) > Flashcards

TBI (Part 1) Flashcards

1
Q

Central Tentorial Herniation

A
  • location:
    • midbrain and pons
    • RAS
  • Effects:
    • decerebrate rigidity
    • coma
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2
Q

Tonsilar Herniation

A
  • Location:
    • cerebellar tonsils
    • RAS
    • indirect activation pathways
    • vasomotor center
  • Effects:
    • neck p! & stiffness, Cerebellar sx
    • coma
    • flaccidity
    • altered pulse, RR, BP
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3
Q

Vascular Changes: Hemorrhage

A
  • occurs at the poles: inf. frontal and temporal

hemotoma:

  • epidural: skull and dura (caused by trauma)
  • subdural: under dura (caused by trauma)
  • subarachnoid: between brain and dura
  • intracerebral
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4
Q

Vascular Changes: Hypoxia/hypotension

A
  • poor perfusion to brain when unconscious
  • watershed sx
  • areas most affected by anoxia:
    • hippocampus
    • basal ganglia
    • cerebrum
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5
Q

Neurochemical changes

A
  • inflammatory response
  • increase in release of excitatory NT (glutamate)
    • inc. ion channel leakage —> inc. CSF and swelling
  • membrane depolarization—> non-selective Ca channel gates open —> cell death
  • release of free radical and cytokines
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6
Q

TBI Evaluation Procedure

A

-

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7
Q

Glasgow Coma Scale

A
  • measures levels of consciousness
  • eye opening: 1-4
  • motor response : 1-6
  • verbal response: 1-5
  • score range 3-15
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8
Q

Acute Management of TBI

A
  • determine severity
  • prevent secondary damage
  • look out for:
    • edema
    • inc ICP
    • bleeding
    • hypotension
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9
Q

Neuroimaging for TBI

A
  • head CT (if unconscious > 2min)
  • monitor intracranial pressure/perfusion
  • surgical intervention
  • seizure prophylaxis
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10
Q

ICP Monitoring

A
  • monitoring through extra ventricular drain, subdural bolt, fibroptic catheter
  • 5-19mmHG = normal
  • 20mmHG - 40 mmHG= correlated with neurological dysfunction
  • 40-60 mmHG = 6x high risk of death
  • > 60mmHG = death
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11
Q

Managing Elevated ICP

A
  • changes in position: elevate HoB
  • medication: sedation, barbiturates
    • MD induces coma
  • hypothermia
  • osmotherapy
  • surgical decompression
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12
Q

ICP & Central Perfusion Pressure (CPP)

A
  • mean arterial pressure (MAP) = average pressure during one cardiac cycle
  • Central Perfusion Pressure (CPP) = difference between mean MAP and venous back pressure
  • 60-80 mmHg = normal CPP
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13
Q

Neurosurgery

A
  • Goals:
    • releases pressure
    • evacuate blood
    • remove derby
  • surgery
    • craniotomy (skull flap is replaced)
    • burr holes
    • cranectomy
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14
Q

Dysautonomia

A
  • paroxysmal sympathetic hyperactivity (sympathetic storming)
  • inc. HR, RR, BP
  • diaphoresis
  • hyperthermia
  • hypertonia
  • teeth grinding
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15
Q

Other Acute Care Considerations

A
  • oral care
  • integumentary care
  • GI issues
  • endocrine issues
  • MSK
    • stabilize/immobilize fx
    • contracture prevention
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16
Q

Other Neurological Involvement

A
  • undx SCI
  • peripheral or plexus injuries
  • CRPS
  • Seizures
  • CSF leas via nose or ears
  • inc’d seizure risks
17
Q

Neuromuscular Impairments in TBI

A
  • motor control impairments
  • hemiparesis
  • abnormal tone
    • decorticate (abnormal flexion posturing)
    • decerebate (extension posturing)
  • somatosensory impairments
  • impaired postural control
18
Q

Cognitive Impairments in TBI

A
  • impaired consciousness
  • decreased attention/concentration
  • impaired executive function
  • memory impairments
  • difficulty learning new things
19
Q

Behavioral Impairments in TBI

A
  • Agitation
  • inflexibility
  • impulsivity
  • disinhibition
  • emotional lability
  • irritability
20
Q

post traumatic amnesia (PTA)

A
  • Unable to form new memories
  • Assess my neurophysiologist every day
    • Date, time, place, situation

A prognostic indicator

21
Q

Rancho Los Amigos levels of cognitive function

A
  • Used to identify…
    • Cognitive level
    • Track changes over time
    • Develop an advanced the plan of care
  • May be used as admission criteria to rehab units
  • Does NOT predict long-term outcomes
22
Q

ranchos los amigos cognitive function scale levels

A
  • Level I: no response
  • Level II: generalize response
  • Level III: localized response
  • Level IV: confused and agitated
  • Level V: confused and inappropriate
  • Level VI: confused and appropriate
  • Level VII: automatic appropriate
  • Level VIII: purposeful appropriate
23
Q

RLCFS: Level I-III

A
  • Level I: no response to stimuli
  • Level II: inconsistent, limited response
    • No specifics
    • vocal; changes in heart rate, blood pressure, sweating; gross motor body movements
  • Level III: inconsistent but relevant
    • response to simple task and pain
24
Q

RLCFS: Levels IV-V

A
  • Level IV: aggressive driven by confusion
    • Decreased attention; behavior isn’t purposeful
    • Heightened state of activity
    • Memory (long and short term) impaired
  • Level V: increased distractibility, unable to learn new material
    • verbal (confabulatory); simple task
25
Q

RLCFS: Levels VI-VIII

A
  • Level VI: goal oriented; follow simple consistently
    • Can follow a schedule; poor insight
  • Level VII: out of post traumatic amnesia; fall schedule
    • New learning with extra time; unable to recall every daily detail
  • Level VIII: (I) at home; recalls past with current experience
    • May have difficulty with problem-solving; stress management; abstract reasoning
26
Q

Severity of TBI

A

GCS | PTA | LOC
Mild | 13-15 | < 1 day | 0-30 min
Mod | 9-12 | > 1 to >7 days | > 30 min to 24 hrs
Severe | 13-15 | < 7day | > 24 hrs

27
Q

TBI Prognostic Indicators

A
  • age: 5-30 years old (+)
    • 0 to 4 years old = 62% mortality within first year
    • Older adults = longer rehab; slower coverage; increased cognitive impairment at discharge
  • Coma/PTA: >1 month = 50% of getting out
    • PTA length is best indicator of long-term outcomes and memory impairment
  • Have increased risk of cognitive decline later in life
28
Q

Cardiopulmonary: Ventilation

A
  • ventilator/ tracheostomy placement
29
Q

TBI Classification

A
  • Primary injury
  • Blast injury
  • Secondary injury
  • Goal is to figure out which category the patient is in and how that patient will present*
30
Q

DAI Grading Scale

A
  • Grade I = microscopic level evidence in cortex
  • Grade II = grade I + corpus callosum
  • Grade III = grade II + brainstem lesion
31
Q

Sub falcons Herniation

A
  • Location
    • Frontal/parietal brain extends under flax cerebri
  • effects:
    • Compresses ACA with hemiparesis
    • LE > UE
32
Q

Infection

A
  • ex:
    • encephalitis (subdural/epidural)
    • meningitus (membrane around brain)
    • abscess (within brain)
    • pneumonia
    • integumentary infection
  • other sites
    • tubes: IV, catheters, ventilators, ICP monitor
33
Q

Common Locations of DAI

A
  • Discrete areas
    • parasagittal white matter of cerebral cortex,
    • corpus callosum
    • brainstem: Pontine mesencephalic Junction
34
Q

Diffuse Axonal Injury

A
  • Occurs during acceleration- deceleration
  • Microscopic injury of the white matter axons related to sheer/stretch/tensile strain
  • Axons twist and tear at the gray and white matter junction
  • Common and high speed motor vehicle accidents and sports
  • Leads to wallerian type axonal degeneration
35
Q

Common Points of Injury

A
  • Interior tempural poles
  • Frontal poles
  • Lateral and inferior temporal Cortices
  • Orbital frontal cortices

-coup-contra coup injury (slide 19)

36
Q

Primary Injuries

A
  • Direct trauma to the parenchyma
    • Brain tissue comes in contact with an object (skull, bullet, sharp object)
  • Rapid acceleration/deceleration of brain
    • Diffuse axonal injury
    • Tissue tearing
    • Intracerebral hemorrhage
37
Q

TBI Pathology

A
  • Brain damage results from
    • External forces;
    • rapid acceleration/deceleration forces;
    • blast waves from explosion
38
Q

Leading Causes for each age group

A
  • Falls
    • 55% = children (0 to 14 years old)
    • 81% = older adults (65+)
  • MVA
    • 15 to 55 yrs old
39
Q

Causes of TBI

A
  • Falls = 40%
  • Unintentional struck by or against an object = 17%
  • Motor vehicle accident = 14%
  • Assault = 10%
  • Unknown/other

Neuro Rehab II (4 decks)

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