TBI & Rancho's Levels Flashcards
Coup Injury
- forceful blow to a resting, moveable head
- MAX injury is @ cranial impact
- contusion w/ or w/o skull fracture
Contracoup Injury
- injury OPPOSITE to a moving head
- usually affects frontal & temporal lobes
Coup/Contracoup Injury
- aka whiplash
- multiple areas of the brain damaged
Primary damage (3 things)
- compression
- tensile (stretch)
- shearing: most detrimental;
DAI = diffuse axonal injury - axons tear away from the cell body
Secondary Damage (4)
- Brain swelling:
ICP > 12mmHg, can lead to hypoxic ischemic injury - Anoxia: w/o oxygen
due to drowning - Hypotension: esp. if brainstem is injured
- Hematoma: rupturing of blood vessels, usually due to a compression injury
- Epidural: blood between skull & dura
- Subdural: between dura & arachnoid space
Mild TBI
- no loss of consciousness
- usually concussion or sport/recreation accident
- ST consequence: second impact syndrome - CSF leaks through foramen magnum due to increase in ICP
- LT consequence: mild cog impairment or Alzheimers, chronic traumatic encephalopathy, depression
Moderate TBI
- LOSS of consciousness - few min to hours
- days/weeks of confusion
- physical, cognitive, and/or behavioral deficits may lasts months or be permanent
- can make complete recovery
Severe TBI
- Coma or prolonged unconsciousness
- can recover but deficits will remain
Glascow Coma Test
- 3 categories
- final score
Categories:
- Eye opening (E) - max 4
- Verbal response (V) - max 5
- Motor response (M) - max 6
12 good recovery
Max = 15
Decorticate posture
arm flexion & leg extension (grade 3 on glascow coma test)
Decerebrate posture
arm & leg extension (grade 2 on glascow coma score)
Level I
No Response; Total Assistance
complete absence of observable change in behavior to any stimuli
Level II
Generalized response; Total assistance
generalized reflex response
response to repeated auditory stimulus
gross body mvmt or non purposeful vocalization in response to external stimulus
inconsistent & delayed responses
Level III
Localized response; Total assistance
withdrawal or vocalization to painful stimulus turn head away/toward auditory blink w/ bright light follows moving object inconsistent to simple commands
Level IV
Confused/Agitated; Max assistance
alert & in heightened state remove restraints motor activities w/o apparent reason brief & nonpurposeful moments of attention aggressive or flight behavior unable to cooperate w/ treatment
