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Neuromuscular > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

Early Treatment of TBI

A

-open airway
-vital signs
-neuro checks 15-30 mins

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2
Q

Glasgow Coma Scale

A

-used on scene of accident, ER, acute care
-predictor of outcomes, research
-3-15 (3 is dead/coma)
-eye opening, motor response, verbal

3-8: severe, coma, 44% of people
9-12: mod injury
13-15: mild
E,V,M (t=cant be scored)

Limitations:
-language
-apahsia
-alcohol
-other injuries

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3
Q

Primary Impact of TBI

A

-Local brain injury: at site of impact on skull
-Diffuse brain injury: widely scattttered shearing of axon, DAI

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4
Q

DAI

A

-diffuse axonal injury
-shearing and stretching of neurons
-high velocity accidents

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5
Q

Secondary Insults of TBI

A

-Rasied Intraranial Pressure
-Intracranial Infection: skull, objects, hair introducing bacteria
-Cerebral Arterial Vasospasm
-Hydrocephalus
-Post-Ttraumatic Epilepsy
-Brain Edema
-Arterial hypoxemia: 1/3 people, breathing issues
-Arterial Hypotension
-Anemia: blood loss from injury
-Hyponatremia: low sodium
-Intracranial hematoma (epidural, subdural, intracerebral)

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6
Q

Raised Intracranial Pressure (norms/treatment)

A

-0-10mmHg is normal when lying down
-20 is abnormal
->20 is a contraindication for PT
-20-40 causes dysfunction
-60 usually causes death

Treatment:
-osmotic therapy
-sedative/coma
-vasoreductive therapy: hyperventilation
-EVD
-muscle relaxants
-core temperature/therapeutic hyothermia

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7
Q

Cerebral Arterial Vasospam

A

-spasm of artery causing reducttion of blood flow to the brain
-after hemorrhage, blood irritates the area
-Measured by transcranial doppler: velocities of blood >100, no out of bed exercises

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8
Q

Hydrocephalus

A

-fluid on the brain
-too much CSF on the brian
-ventricles appear larger

Causes:
-swelling
-blocking of aquaduct or foramen

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9
Q

Post-Traumatic Epilepsy

A

-seizure risk increases post TBI

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10
Q

Brain Edema

A

-swelling of brain tissue/cells
-ventricles appear smaller

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11
Q

Secondary Damage from TBI

A

-brain will move away from mass lesion (distortion, midline shift, herniation through foramen magnum)
-Hypoxic and ischemic brain damage: hippocampus, basal ganglia, cortex, cerbellum

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12
Q

Surgical Interventions for TBI

A

-craniotomy or craniectomy: need helmet when out of bed
-debridmentt to minimize infection
-insertion of device to measure ICP: ventriculostomy with EVD

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13
Q

Hypoxia vs. Ischemia

A

-lack of o2 vs. blood flow issue

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14
Q

External Ventricular Drain

A

-EVD
-pressure transducer at same levels of ventricles (auditory meatus)
-must be re-level when pt moves
-drains when appropriate

PT:
-EVD must be clamped and managed by nurse
-look at color

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15
Q

Medications for TBI

A

-anticonvulsants: seizures
-corticosteriods: inflammation
-sedatives: medically induce coma
-muscle paralytics/relaxers
-CV meds
-antibiotics
-narcotics

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16
Q

Metabolic Care w/ TBI

A

-catheter
-electrolytes
-artificial feedings: NG, G (gastrtostomy), J (jejunostomy) tube (3000kcal) per day

17
Q

Pulmonary Complications w/ TBI

A

-Neurogenic Pulmonary Edema: increased microvascular permeability
-fat embolism
-Respiratory Acidosis, from
-Pneumonia

18
Q

Fever with TBI

A

-increase caloric demand
-increased metabolic demand on brain
-infection
-damage to hypothal
-sign of brain irritation

19
Q

HTN w/ TBI

A

-systemic arterial hypertension can result in BBB dysruption
-caused by noxious stimuli
-loss of autoregulation of BV increases blood-brain volume

20
Q

Heart Rate w/ TBI

A

-tachycardia MC
-controlled by diencephalon to medulla

21
Q

Discharge Placement

A

-many pt need support but return to independence within 1-2y
-some go to nursing homes (21%)
-(32%) lived with parents
-31% spouses
-3% living alone

22
Q

Predictors of Outcome

A

-location
-size
-local vs. Global
-LOC
-Post traumatic amnesia
-age
-Hx

23
Q

Mild Traumatic Brain Injury

A

Disruption of brain function:
-loss of consciousness
-loss of memory
-change in mental state
-focal neuro deficits

Severity does not exceed
-LOC ~30min
-GCS of 13-15
-Post traumatic amnesia <24h

S/s usually show 1yr later
-Physical: headache, n/v, dizziness, sleep issues, fatigue, vision issues
-Cognitive: attention, concentration, perception, executive function
-Behvaioral: irritability, disinhibition, emotional lability

24
Q

Decerebrate Posturing

A

-damage to brainstem between midbrain and pons
-Extension everywhere (not hands)

25
Q

Decorticate Posturing

A

-damage to superior midbrain or cortex
-Extension LE and flexed UE

26
Q

Coma

A

-appears asleep
-no longer than 2 weeks

27
Q

Persistent Vegetative State

A

-PVS
-can have eyes open
-cant folow commands
-sleep wake cycles

28
Q

Post-Traumatic Amnesia

A

-period after incident of not remembering
-lastt 3-4 times length of unconsciousness

Neuromuscular (21 decks)

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