Trauma Flashcards
TBI - pathophys - primary brain damage - diffuse axonal injury
disruption and tearing of axons and small BVs from shear strain of angular acceleration
results in neuronal death and petechial hemorrhages
TBI - pathophys - primary brain damage - focal injury
contusions, lacerations, mass effect from hemorrhage and edema
TBI - pathophys - primary brain damage - Coup contracoup injury
injury at point of impact and opposite point of impact
TBI - pathophys - secondary brain damage - hypoxic-ischemic injury
results from systemic problems that compromise cerebral circulation
TBI - pathophys - secondary brain damage - swelling/edema -
can result in mass effect, with inc intracranial pressures, brain herniation, and death
TBI - pathophys - concussion
loss of consciousness either temporary or permanent - resulting from injury or blow to head with impaired functioning of brainstem reticular activating system (RAS)
TBI - recovery stages from diffuse axonal injury - coma
state of unconsciousness in which there is neither arousal nor awareness
eyes remain closed
no sleep/wake cycles
TBI - recovery stages from diffuse axonal injury - unresponsive vigilence/vegetative state
marked by the return or sleep/wake cycles and normalization of vitals
persistent veg state id remains in veg state for over 1 yr of TBI
TBI - recovery stages from diffuse axonal injury - mute responsiveness/minimally responsive
state in which pt is not vegetative and does show signs, even if intermittent, of fluctuating awareness
TBI - recovery stages from diffuse axonal injury - confusional state
mainly a disturbance of attention mechanisms
all cognitive operations are affected
pt is unable to form new memories
may demonstrate either hypoarousal or hyperarousal
TBI - recovery stages from diffuse axonal injury - emerging independence
cofusion is clearing and some memory is possible; significant cognitive problems and limited insight remain; frequently uninhibited social bx
TBI - recovery stages from diffuse axonal injury - intellectual/social competance
inc indp. although cog difficulties persist along with bx and social problems
SCI - etiology - traumatic causes
MVA (most common cause of SCI)
jumps, falls, diving, gunshot wounds
SCI - etiology - mechanism of injury
flexion - most common for lumbar
flexion-rotation - most common for cervical
compression, hyperextension
SCI - spinal areas of greatest frequency of injury
C5, C7, T12, L1
SCI - nontraumatic causes
disc prolapse, vascular insult, cancer, infection
SCI - pathophys - primary injury -
interruption of blood supply
SCI - pathophys - secondary sequelae -
ischemia, edena, demyelination, necrosis of axons, progressing to scar tissue formation
SCI - classification - level of injury -
lesion level indicates most distal uninvolved nerve root segment with normal function
MM must have a grade of at least 3+ or fair+ function
SCI - tetra/quad
injury occurs between C1 and C8 levels, involves all 4 extremities and the trunk
SCI - para
injury occurs between T1 and T12-L1
Involves both lower extremeties and trunk
SCI - degree of injury - complete
no sensory or motor function below level of lesion
SCI - degree of injury - incomplete
preservation of sensory or motor function below level of inury; spotty sensation, some mm function
SCI - ASIA scale A
complete, no motor or sensory function is preserved in sacral segment S4/5
SCI - ASIA scale B
incomplete, sensory but no motor function is preserved below neuro level and includes sacral segments S4/5
SCI - ASIA scale C
incomplete, motor function is preserved below neuro level and most key muscle below the neuro level have a muscle grade of less than 3
SCI - ASIA scale D
incomplete, motor function is preserved below the neuro level, and most key mm below neuro level have a muscle grade of 3 or more
SCI - ASIA scale E
normal - motor and sensory function is normal
SCI - clinical syndromes - central cord syndrome
loss of more centrally located cervical tracts/arm function, with preservation of more peripherally located lumbar and sacral tracts/leg function
Typically caused by hyperextension injuries to C spine
SCI - clinical syndromes - Brown sequard syndrome
hemisection of spinal cord typically caused by penetration wounds (gunshot or knife) with asymmetrical symptoms
SCI - clinical syndromes - Anterior cord syndrome
damage is mainly in anterior cord resulting in loss of motor function, pain and temp with preservation of light touch, prop, and postiion sense
Typically caused by flexion injuries to C spine
SCI - clinical syndromes - Posterior cord syndrome
loss of post columns with preservation of motor function, sense of pain and light tough
extremely rare
SCI - clinical syndromes - cauda equina
injury below L1 results in injury to lumbar and sacral roots of peripheral nerves (LMN) with sensory loss and parlysis and some capacity for regeneration
LMN lesion with auonomous or nonreflex bladder
SCI - clinical syndromes - sacral sparing
sparing of tracts to sacral segments, with preservation of perianal sensation, rectal sphincter tone, or active toe flexion
WC - patients with high cervical lesion (C1-C4)
electric wc with tilt in space seating or reclining seat back
microswitch or puff and sip controls
WC - pts with cervical lesions, shoulder function, elbow flexion (C5)
manual chair for propulsion with aids
indp. for short distances on smooth flat surfaces
may choose electric for longer distance for energy conservation
WC - pts with cervical lesions, radial wrist extensors (C6)
manual wheelchair with friction surface hand rims
indpendent
WC - pts with cervical lesions, triceps (C7)
manual wc with friction surface hand rims with icnreased propulsion
WC - pts with hand function (C8-T1 and below)
manual wc with standard hand rims
Locomotor training - pts with midthoracic lesions (T6-9)
supervised ambulation for short distances
require KAFOs and crutches
swing to gait pattern
Locomotor training - pts with high lumbar lesions (T12 - L3)
inp in ambulation on all surfaces and stairs using swing through or four gait pattern with bilateral KAFOs and crutches
LT - pts with low lumbar lesions (l4-5)
inp with bilateral AFOs and crutches or canes
