Traumatic Brain Injury

Question 1

Ranges of ICP

Answer 1

Normal = 5-20 cm H2O
Elevated = >20
Critical = > 25

Severe elevated ICP typcially results in brain herniation & needs medical emergency treatment

Older ppl = make take longer for CP to INC to critical lvls b/c they may have cerebral atrophy (size decrease d/t aging) = more room in the skull for swelling to set in before it compresses

Question 2

Glasgow Coma Scale

Answer 2

-Measures level of consciousness
Total score between 3-15
- Severe < 8
- Moderate 9-12
- Severe 13-15

Activity: eye opening, motor response, verbal response

Study chart on pg. 293 - Distinction between severity of TBI

Question 3

The Rancho Los Amigos Level of Cognitive Functioning (LOCF)

Answer 3

Descriptive scale used to track cognitive and behavioural recovery as patient emerges from a coma
- useful for communication of status and treatment planning
- used when patients met the ceiling of GCS

Question 4

The Rancho Los Amigos Level of Cognitive Functioning (LOCF):
Level I

Answer 4

Level I - no response

• patient appears to be in a deep sleep and is completely unresponsive to any stimuli

Question 5

The Rancho Los Amigos Level of Cognitive Functioning (LOCF):
Level II

Answer 5

Level II - generalized response

• Patient reacts inconsistently and nonpurposefully to stimuli in a nonspecific manner

Question 6

The Rancho Los Amigos Level of Cognitive Functioning (LOCF):
Level III

Answer 6

Level III - localized response

• Patient reacts specifically but inconsistently to stimuli

Question 7

The Rancho Los Amigos Level of Cognitive Functioning (LOCF):
Level IV

Answer 7

Level IV - confused-agitated

• Patient is able to respond to simple commands fairly consistently…etc…however

Question 8

The Rancho Los Amigos Level of Cognitive Functioning (LOCF):
Level V

Answer 8

Level V - confused-inappropriate

• Patient is able to respond to simple commands fairly consistently…etc…however

Question 9

The Rancho Los Amigos Level of Cognitive Functioning (LOCF):
Level VI

Answer 9

Level VI - confused-appropraite

• Patient shows goal-directed behaviour but is dependent on external input or direction

Question 10

The Rancho Los Amigos Level of Cognitive Functioning (LOCF):
VII

Answer 10

Level VII - autonomic-appropraite

• Patient appears appropriate and oriented within the hospital and home setting … etc… judgement remains impaired

Question 11

The Rancho Los Amigos Level of Cognitive Functioning (LOCF):
Level VIII

Answer 11

Level VIII - purposeful-appropriate

• Patient is able to recall and integrate past and recent events and aware of and responsive to environment… etc [may not be normal]

Question 12

Galveston Orientation & Amnesia Test (GOAT)

Answer 12

Typical orientation questions; include name, city, recall of how patient is, where they are, day, date, month, year, and event of the injury

• helps in determining outcome or prognosis

Question 13

Prognosis - Predictors of poor outcomes…

Answer 13

• Low initial GSC score = more severe injury
• Lower educational level
• Very young age (<7) or older age (>40)
• Longer periods of post-traumatic amnesia (<34 days likely to have good overall recovery)