Traumatic brain injury Flashcards
what are 3 early medical management for TBI
- establish open airway
-vital signs , fluid replacement - neuro checks q 15 to 30 mins
what are the 3 things Glasgow coma scale is used for
Used at the scene of accident, ER, and throughout
acute care
Used as a predictor of outcome
Used in research
does the GLasgow coma sacle have low or high inter rather reliability
high
what is range of scores u can see for the Glasgow Coma Sclae
3-15
what do the Glasgow coma scale scores mean
3 to 8 - severe injury (defines coma in 90% of cases)
9 to 12 - mod injury (15%)
13 to 15 - mild injury (41%)
what are the 4 limitations of GCS
Pre-existing conditions (language)
Aphasia
Alcohol or medications
Other
what is local brain injury
localized to the site of impact on the skull
what is a diffuse brain injury
widely scattered shearing of axons (DAI: diffuse axonal injury)
is raised intracranial pressure a secondary or primary insult
secondary
what is the normal intracranial pressure while lying down
0-10 mmHg
what intracranial pressure is definitely abnormal and what is a definite contraindication for P/.T
20 mmHg is definitelyabnormal.
Above 20 is definite contraindication for P.T
what intracranial pressure casues neurologic dysfunctions
20-40 mmHg
what intracranial pressure almost always results in death
60 mmHg
what is cerebral arterial vasospasm measured by
transcranial doppler
Brain’s ___ properties allow it to move
away from the mass lesion
viscoelastic
Brain’s viscoelastic properties allow it to move
away from the mass lesion causing what 3 things
Distortion
Midline shift
Herniation through foramen magnum
hypoxia and ischemic brain damage is most commonly seen in what 4 things
hippocampus, basal ganglia,
scattered sites of cerebral cortex, and cerebellum
what is the difference between hypoxia and ischemia
hypoxia is absence in O2 from problems with breathing. system and ischemia is blood loss to area bc it is blocked
what are the 2 what u can evacuate the hematoma
craniotomy or craniectomy
what is done to minimize infection of compound wounds
debridement and lavage of compound wounds
what is a Ventriculostomy
measures and drains CSF
what does a Bolt do
measures CSF only
for the EVD the pressure transducer is at the same horizontal level as ____ and what is the landmark
ventricles and external auditory meatus
prior to moving someone with w EVD what needs to be clamped
EVD must be clamored by nurse or by pt/ot w nerve permisson
if you have a EVD what must happen every time the patient moves
EVD must be releveled
-osmotic therapy
-sedative/hyponotic drug therapy
-vasoreductive therapy
-skeletal mm paralytics and/or relaxants
- core temperature/therapeutic hypothermia
- these are treatments of for what
ICP
what is the metabolic care for ICP
In-dwelling catheter with strict intake/output
Serum electrolytes
Artificial feedings once bowel sounds return
what is neurogenic pulmonary edema associated with
associated with increased pulmonary microvascular permeability
what are pulmonary complications that could arise from a tBI
Fat embolism in lung
Respiratory acidosis from artificial ventilation
Pneumonia
- neurogenic pulmonary edema
fever can be a sign of infection most commonly of what
respiratory and urinary tracts
fever can be caused by damage to ___ and called what
hypothalamus
“neurogenic fever”
what 2 things do fevers cause
increased caloric demand and metabolic demands of the brain
a fever can be a sing of what
irritation with brain herniation
what can systemic arterial hypertension result in
blood- brain barrier disruption, causing more brain edema.
what can systemic arterial hypertension be caused by
noxious stimuli
loss of autoregualtion of cerebral blood flow does what
increases blood brain volume leading to intracranial hypertension
what is HR controlled by
various regions in diencephalon caudally to myelencephalon (medulla)
what HR problem is most common is TBI
tachycardia
Disability Rating Scale (DRS)
Craig Handicap Assessment and Reporting Technique (CHART)
and Short Form
Participation Objective/Participation Subjective (POPS)
Supervision Rating Scale
Discharge placement
Employment
these are all examples of what ICF level outcome
participation
Universal Data System-Functional Independence Measure (UDS-
FIM)
UDS-FIM + FAM (Functional Assessment Measure)
these are all apart of what ICF level outcome
activity
Glasgow Coma Scale (GCS)
Rancho Levels of Cognitive Function
JFK Coma Recovery Scale Revised
Agitated Behavior Scale
Moss Attention Rating Scale
these are all apart of what ICF level outcome
body structure/functionn
what is the disability rating scale used to track
ppl from coma to community
what are the 6 things that the craig handicap assessment and reporting technique go over
- physcial indepence
- mobility
- occupation
- social integration
- economic self sufficiency
- cognitive independence
___ of individuals require some level of supervision at 1 year post injury.
37%
__ % require some supervision 2 years post injury.
31
what is a Reliable and valid scale designed to
assess high-level motor performance in patients with TBI
Hi - level mobility assessment tool
what is the minimum mobility requirement for the Hi level mobility assessment toll
independent walking 20 meter without gait aids
there are 13 items of teh HI level mobility assessment tool what are the the 5 things they are assessing
Walking, running
Jumping, balance
Stairs
Hopping
Skipping
what the 8 levels of the ranchos los amigos for cognitive functioning scale
1 No response
2 Generalized response.
3 Localized response
4 Confused, agitated.
5 Confused, inappropriate, non-agitated.
6 Confused, appropriate
7. Automatic, appropriate
8. purposeful , appropriate
if a patient is Unresponsive to any stimulus what rancho levle would u give them
- no response
if a patient is Limited, inconsistent,
non-purposeful responses, often to pain only. what rancho levle would u give them
- Generalized response.
if a patient has Purposeful responses; may
follow simple commands; may focus on presented
object. what rancho levle would u give them
- localized response
if a patient has Heightened state of activity;
confusion, disorientation; aggressive behavior; unable to do self-care; unaware of present events; agitation appears related to internal confusion. what rancho levle would u give them
- confused , agitated
if a patient has Appears alert; responds to commands; distractible; does not concentrate on task; verbally inappropriate, does not learn new information. what rancho levle would u give them
- Confused, inappropriate, non-agitated
if a patient is Good directed behavior,
needs cueing; can relearn old skills (ADL); serious
memory problems; some awareness of self and others what rancho levle would u give them
- confused , appropriate
if a patient has Robot-like appropriate
behavior with minimal confusion; shallow recall; poor insight into condition; initiates tasks but needs
structure; poor judgment, problem-solving and
planning skills what rancho levle would u give them
- automatic , appropriate
if a patient is Alert, oriented; recalls and
integrates past events; learns new activities and can
continue without supervision; cognitively independent in living skills; capable of driving; defects in stress tolerance, judgment, abstract reasoning persist; many function at reduced levels in society. what rancho levle would u give them
- purposeful , appropriate
A patient in ___ appears asleep. There is no eye
opening, even spontaneously, nor movements or
vocalization. Usually no longer than 2 weeks.
coma
A patient in ___ can have eyes open, move
spontaneously, but is unable to follow commands
or speak. This patient has sleep-wake cycles. Can
last indefinitely.
persistent vegetative state
what Scale is used to monitor levels of alertness for patients in coma/persistent vegetative state
JFK coma/near coma scale
Shows emergence from coma/persistent vegetative
state into which ranchos level
minimally conscious state” … level 3
what scale is a huge implications from DC placements from acute care
JFK coma/ near coma scale
what is the period of time from the accident to the
time that the patient starts to have on- going short-term memory.
post traumatic amnesia
what will happen when the pateint wakes up from a coma
often not remember the accident or evens immediately after it
what is Used to determine when a patient is progressing out of PTA (post traumatic amnesia)
GALVESTON ORIENTATION AND AMNESIA
TEST (GOAT
on the GALVESTON ORIENTATION AND AMNESIA
TEST (GOAT) the pateint must have what scored to be out of PTA
3 consecutive scores of > 75
injury to the front ortbial , anterior temporal lobes and slyivan fissues causes what
agitation
what do temporal lobe seizures casues
aggression
what are environments casues of agitation
sensory overload and deprivation
what are the cut off scores for agitated behavior
21 or less:
22-28:
39-25:
>35:
21 or less: within normal
limits
22-28: mild agitation
29-35: moderate agitation
>35: severe agitation
what is an Observational tool to
measure attention-related
behaviors after TBI
moss attention rating scale
the higher the score on the moss attention rating scale means what
better then attention
what is Defined by a traumatically induced disruption of brain function, as manifested by at least one of these:
Any period of loss of consciousness
Any loss of memory for events immediately pre- or post-
accident
Any change in mental state at the time of the accident
Focal neuro deficits (transient or lasting)
mild TBIq
severity of injury for a mild TBI does not exceed a loss of consciousness for ____ mins , after 30 mins an initial GCS of ____ and PTA not greater than ___ hours
30
13-15
24
what are the most common things reported with a mild TBI
headaches
when do activity and participation levels tend to plateau for TBI
1-2 years post injury
for a TBI , importovemtns continues to be seen at ___ post injury and is considered period of “rapid recovery”
1 year
