Traumatic Brain Injury Flashcards
Early Treatment of TBI
-open airway
-vital signs
-neuro checks 15-30 mins
Glasgow Coma Scale
-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
Primary Impact of TBI
-Local brain injury: at site of impact on skull
-Diffuse brain injury: widely scattttered shearing of axon, DAI
DAI
-diffuse axonal injury
-shearing and stretching of neurons
-high velocity accidents
Secondary Insults of TBI
-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)
Raised Intracranial Pressure (norms/treatment)
-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
Cerebral Arterial Vasospam
-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
Hydrocephalus
-fluid on the brain
-too much CSF on the brian
-ventricles appear larger
Causes:
-swelling
-blocking of aquaduct or foramen
Post-Traumatic Epilepsy
-seizure risk increases post TBI
Brain Edema
-swelling of brain tissue/cells
-ventricles appear smaller
Secondary Damage from TBI
-brain will move away from mass lesion (distortion, midline shift, herniation through foramen magnum)
-Hypoxic and ischemic brain damage: hippocampus, basal ganglia, cortex, cerbellum
Surgical Interventions for TBI
-craniotomy or craniectomy: need helmet when out of bed
-debridmentt to minimize infection
-insertion of device to measure ICP: ventriculostomy with EVD
Hypoxia vs. Ischemia
-lack of o2 vs. blood flow issue
External Ventricular Drain
-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
Medications for TBI
-anticonvulsants: seizures
-corticosteriods: inflammation
-sedatives: medically induce coma
-muscle paralytics/relaxers
-CV meds
-antibiotics
-narcotics
Metabolic Care w/ TBI
-catheter
-electrolytes
-artificial feedings: NG, G (gastrtostomy), J (jejunostomy) tube (3000kcal) per day
Pulmonary Complications w/ TBI
-Neurogenic Pulmonary Edema: increased microvascular permeability
-fat embolism
-Respiratory Acidosis, from
-Pneumonia
Fever with TBI
-increase caloric demand
-increased metabolic demand on brain
-infection
-damage to hypothal
-sign of brain irritation
HTN w/ TBI
-systemic arterial hypertension can result in BBB dysruption
-caused by noxious stimuli
-loss of autoregulation of BV increases blood-brain volume
Heart Rate w/ TBI
-tachycardia MC
-controlled by diencephalon to medulla
Discharge Placement
-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
Predictors of Outcome
-location
-size
-local vs. Global
-LOC
-Post traumatic amnesia
-age
-Hx
Mild Traumatic Brain Injury
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
Decerebrate Posturing
-damage to brainstem between midbrain and pons
-Extension everywhere (not hands)
