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Disease 2 > Traumatic brain injury > Flashcards

Traumatic brain injury Flashcards

1
Q

Define traumatic brain injury

A

An alteration in brain function or other evidence of brain pathology caused by an external force

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2
Q

What are the common mechanisms that can cause a TBI?

A

MVC/MCC/ Car vs ped
Fall
Industrial accident
Assault
Sports injury

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3
Q

In regards to TBI, what is a coup?

A

Any blow to the skull

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4
Q

In regards to TBI, what is countrecoup?

A

Blow to the head where the impact transfers through the skull to the opposite side of the head causing damage to the side opposite the initial point of injury

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5
Q

A patient with a mild TBI can present with

A

Headache
Confusion
Dizziness
Memory impairment
Blurred vision
Behavioral changes

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6
Q

A patient with a moderate TBI can present with

A

Repeated nausea or vomiting
Slurred speech
Weakness in arms or legs
Problems with thinking or learning

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7
Q

A concussion is formally referred to as:

A

A diffuse axonal injury

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8
Q

Describe the damage that is associated with a diffuse axonal injury

A

Centripetally applied forces can damage nerve fibers by shearing the fiber or disrupting the myelin sheath
Can result in varying degrees of coma or death

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9
Q

Where is an epidural hematoma located?

A

Between the skull and the dura

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10
Q

Where is a subdural hematoma located?

A

Between the dura and the arachnoid mater

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11
Q

Where is a subarachnoid hemorrhage located?

A

Beneath the arachnoid mater within the subarachnoid space

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12
Q

Describe the Monroe-kelli doctrine

A

There is a limited amount of space in the brain
To compensate for swelling or a mass, the body will remove CSF and venous volume to try to accommodate for the growth.
This is limited and eventually pressure will rise in the intracranial space

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13
Q

What is a normal ICP for a supine patient?

A

10-15 mmHg

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14
Q

When does brain death occur due to increased ICP?

A

When ICP=MAP

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14
Q

What ICP is the ceiling for most ICU patients?

A

20 mmHg

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14
Q

What happens if ICP is 15-20 mmHg?

A

Capillary beds are compressed altering microcirculation

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15
Q

What happens if ICP is between 30-35 mmHg?

A

Provokes edema

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15
Q

What happens if ICP is between 40-50 mmHg?

A

Does not support perfusion

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15
Q

How do we calculate cerebral perfusion pressure?

A

CPP = MAP-ICP

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16
Q

What does a cerebral perfusion pressure of less than or equal to 50 cause?

A

Frank cerebral ischemia

16
Q

What have recent studies shown regarding Cerebral perfusion pressure?

A

Poor outcomes for patient with CPP of less than or equal to 60

16
Q

What is a normal Cerebral Perfusion Pressure? CPP

A

95-80 mmHg

17
Q

What are the categories of responses for the glasgow coma scale?

A

Eye opening response
Verbal response
Motor response

18
Q

What are the eye opening response levels

A

Spontaneously
To speech
To pain
None

19
Q

What are the verbal response levels?

A

Oriented to time, person, place
Confused
Inappropriate words
Incomprehensible sounds
No response

20
Q

What are the motor response levels

A

Obeys command
Moves to localized pain
Flex to withdraw from pain
Abnormal flexion
Abnormal extension
No response

21
Q

When does the glasgow coma scale indicate intubation?

A

Intubation is indicated for GCS < 9

22
Q

Describe decorticate posturing

A

Patient pulls arms up to chest with palms facing down

23
Q

Describe decerebrate posturing

A

Patient puts hands by sides with palms rotated inward and outward

24
Q

A patient you are assessing has pupils that are large and unresponsive to light. The patient is not on drugs, what is this indicative of?

A

Increased ICP leading to paralysis of the optic nerve

25
Q

What is the fancy term for a blown pupil?

A

Mydriasis

26
Q

Impending or ongoing cerebral herniation can be indicated by what?

A

Posturing
Pupillary asymmetry
Mydriasis
Cushing triad

27
Q

What is cushing triad?

A

Hypertension
Bradycardia
Irregular respiration

28
Q

When referring to a TBI, what is meant by the term midline shift?

A

The compression or movement of the ventricles on one side of the brain in response to swelling

29
Q

What can happen if ICP remains unchecked?

A

Brain can be pushed out of its normal position

30
Q

Describe secondary brain injury

A

A cascade of subtle changes in the brain and nervous system following a primary injury

31
Q

What changes can cause secondary injury in the brain?

A

Cerebral edema
Inflammation
Electrolyte imbalances
Hypoxemia
Poor BP control
Poor glucose management
Poor vent management
Seizures

32
Q

What is the cause of cerebral edema in most adults?

A

Vasogenic edema

33
Q

What causes cerebral edema?

A

Increased permeability of the cerebral vasculature/ breakdown of the blood brain barrier

34
Q

What are management options for cerebral herniation

A

Hyperosmolar IV solutions
External ventricular drains
Evacuation of blood clot
Craniectomy

35
Q

How do hyperosmolar solutions manage cerebral herniation?

A

Increased salinity of blood pulls fluid out of tissue reducing swelling
Generally 3% hypertonic saline

36
Q

Describe how extraventricular drains can manage cerebral herniation

A

A catheter is placed in cerebral ventricle allowing for pressure monitoring and fluid drainage to control ICP

37
Q

What is respiratory’s role in traumatic brain injuries?

A

Prevent second degree brain injury
Gentle intubations
Management of ventilation
Management of oxygenation

38
Q

What effects can hyperventilation have on TBI patients?

A

PaCO2 < 25 mmHg can rapidly decrease ICP
Can also reduce blood flow to the brain

38
Q

Why is a gentle intubation important with TBI patients?

A

Intubation can stimulate supraglottic larynx which somehow can spike ICP

39
Q

What should providers be aware of when choosing PEEP settings for patients with TBIs?

A

Increased intrathoracic pressure inhibits venous return to the heart which can increase ICP
Problematic because PEEP is what we use to promote oxygenation

40
Q

What are the guidelines regarding hyperventilating TBI patients?

A

Prophylactic hyperventilation should be avoided
PaCO2 of 25-30 mmHg can sometimes be used as a temporary measure to resolve and ICP crisis
Hyperventilation induced vasoconstriction can cause secondary ischemia and worsen patient outcomes

41
Q

When can hyperventilation of TBI patients be especially harmful?

A

In the acute phase, 24-48 hours after injury

42
Q

If a patient with a TBI experience mental status changes, what needs to be performed?

A

A CT scan

Disease 2 (16 decks)

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