TBI's and SCI's Flashcards
what is a primary injury?
effect on the brain at the time of injury
examples of causes of a primary injury?
trauma- contusion, damage to blood vessels, axonal shearing, contusion, epidural/subdural hematoma, SAH, DAI
what is axonal shearing?
when the axons of neurons are stretched and torn
what is a secondary injury?
complications that result in additional changes and dysfunction of brain tissue
after injury resulting in further damage or even death
examples of secondary injuries?
hypoxemia, hypotension, hypo/hyperglycemia, increased metabolic demands, loss of auto regulatory mechanisms, increased ICP, hypo or hypercapnia
what is a DAI?
diffuse axonal injury, is a form of TBI
when do DAIS occur?
when the brain rapidly shifts inside of the skull as an injury is occurring; the axons in the brain are sheared as the brain accelerates and decelerates inside of the skull
what part of the brain do DAI’s occur in?
many parts of the brain
what happens to most patients with a DAI?
comatose state
how is clinical presentation assessed?
using the GCS
what GCS score indicates a mild TBI?
13-15
what GCS score indicates a moderate TBI?
9-12
what GCS score indicates a severe TBI?
<8
what might a mild TBI cause?
functional deficits weeks or months following injury
What might we be able to see on a CT?
hematomas, bleeding, fractures, cerebral edema
what might we be able to see on an MRI?
DAI, brain stem injury, traumatic aneurysms
what does management of TBIs focus on?
optimizing functional recovery and prevention of secondary injury
things assessed and monitored to prevent secondary injury?(8)
airway oxygenation ventilation fluid management ICP cerebral perfusion preventing increased cerebral oxygen demand preventing complications
ways to support cerebral perfusion?
pressors: dopamine levo neosynephrine epinephrine EEG
what are some examples of secondary complications?
pneumonia
PE
DVT
skin integrity
Ways to prevent secondary complications?
blood thinners
lung assessments
oral care
q2h turns
what are some examples of skull fractures?(3)
linear
depressed
basilar
what is a linear fracture?
generally not displaced, a hairline fracture
what is the treatment for a linear fracture?
no tx needed
what is a depressed fracture?
inward depression of bone fragments
what is a treatment for a depressed fracture?
surgery
what is the main concern with depressed fractures?
brain damage
what is a basilar fracture?
involves the base of the skull
CSF leaks from nose/ears indicates dural tear
what is a major indicator of a basilar fracture?
battles sign- bruising behind the ears
what is the best way to test for a CSF leak?
pH paper
what are the most common causes of SCI’s?
- MVA
- falls
- acts of violence
- sports-related
what is the most common cause of a SCI?
MVA with 48% resulting from them
what is the most common population to get a SCI from a fall?
the elderly
what does an SCI result from?
bone, disk material, or foreign object entering the spinal canal and disrupting the spinal cord or blood supply
What are the mechanisms of injury for an SCI?
- whiplash (hyperflexion/extension)
- axial loading, compression (diving and hitting head)
- rotation
- penetrating trauma (knife, GSW)
types of SCI damage?
- concussion (shaking of brain, spinal cord)
- contusion (bruising)
- laceration(cut)
- transection (severing)
- hemorrhage (bleeding out)
- blood vessel damage
what will you see with secondary injury?
HA, changes in LOC, respiratory fx
what is neurogenic shock shown by?
MAP, CVP, CPP loss autonomic nervous system influence (T1-L2) decreased HR vasodilation edema
what is an incomplete SCI?
varying degree of sensory and motor function disruption because some tracts intact
what is a complete SCI?
total loss of sensory and motor function below level of injury
caused by complete interruption of pathways
what is the presentation with neurogenic shock?
hypotension, warm-flushed skin, diaphragmatic breathing
treatment for neurogenic shock?
- dopamine
- vasopressin
- ephedrine
- norepinephrine
- phenylephrine
- atropine
what is the first line treatment for neurogenic shock?
phenylephrine
what is an example of a muscle relaxant?
cyclobenzaprine
what is an example of an anticonvulsant?
levatiracetam
what is an example of an antineuropathic?
gabapentin
what is autonomic dysreflexia?
a life threatening condition in pts with injury at or above T6
what can autonomic dysreflexia precipitate?
seizure or stroke
what is autonomic dysreflexia caused by?
unopposed sympathetic response below level of injury
when can autonomic dysreflexia occur?
anytime after spinal shock resolves, usually in first year after injury
what triggers autonomic dysreflexia?
- over distended bladder
- full rectum
- infection
- pressure sore
- pain
what is the most common cause of autonomic dysreflexia?
over distended bladder
what does the stimulus from causes of autonomic dysreflexia cause?
marked elevation in blood pressure
symptoms of autonomic dysreflexia?
- severe HA
- nasal congestion
- SOB
- nausea
- blurred vision
- facial flushing
- diaphoresis
- piloerection
- anxiety
what is the difference between neurogenic shock and autonomic dysreflexia?
shock has hypotension and bradycardia
autonomic dysreflexia is a hypertensive crises