Traumatic Brain Injury Flashcards
Incidence
3: 1 male
bimodal: <5 yo and 15-24 years old
Prevalence
mortality of MVA decreased due to increased safety of vehicles
Risk factors of TBI for >65 yo
female poor vision dementia history of falls polypharmacy
Closed Headed Injury
Mass effect
non penetrating
acceleration/deceleration blow
ranges from minor to irreversible
brainstem white mattage shear force= damged CN,BV, CSF rhinnorhea
Open Headed injury
penetrating of meninges
acceleration/deceleration force
Fracture with head injury
increased risk for
meningitis
encephalitis
infection
abscess
Primary damage
contact moi, coup contra coup effect, local to site
non contact moi, shear force, diffuse
Secondary damage
hypoxic ischemia due to vascular insult an arterial hypoxemia
intracranial hematoa
increased cranial pressure/hydrocephalus
mass effect from edema
Cause of secondary damage
increased cranial pressure= dec cerebral perfusion
electrolytes imbalance
hypoxic/hypotension
neuro/celluar change
ischemia
pathogenesis of head injury
laceration to neural tissue
contusion forcing hematos
shear force with rotation
instantaneous rise if ICP above 40mmHg
Immediate complication
vasogenic edema (increased permeability with extracelluar fluid)
cytotoxic edema
CSF in steady state with extracelluar fluid
Glasgow Coma scale
eyes opening (1-4)
speech (1-5)
following of motor commands (1-6)
13-15=mild
9-12=mod
<8=severe
Mild head injury
concussion
uncomplicated, requires family to observe
Concussion definition/characteristics
violent shaking leading to temporary disturbance in brain
can be with or without consciousness
mild axonal injury
microscopic change in neurons/glial cells w/in hours
Post concussive syndrome
rest is best treatment
HA, decrease memory, irratability, insomnia
s/s for weeks to months
limited ability to complete ADLs
controversial psychological/subjective
Acute epidural hemorrhage
no coma
no tx=neurological deterioration
Acute subdural hemorrhage
if not resolve may lead to coma
needs surgery
bleeding stops due to ICP
Chronic subdural hemorrhage
slow venous leaking
mistaken for tumor/mass
needs surgery
neurological deterioration
Subarachnoid hemorrhage
treat like epidural
Cerebral hemorrhage
disrupted cerebral circulation
manage similar to hypertensive strokes
Severe head injuries in general
LOC multiple sites (SCI, ribs, eyes) permanent deficits will persist
Brain dead
if greater than 30mins
no response to stim/no reflexes (poor eeg <2microvolt)
ventilator needed (apenea)
can’t maintain homeostasis
Persistent vegetable state
wakefull but decreased cerebral functioning
PVS long than 3 months=poor prognosis
primitive reflex
Near drowning Incidence and Definition
15-20% dry drowning (laryngeal spasm)
80% wet drowning with aspiration of fluid (asphysia)
defined: surviving past 24 hours after a hypoxic event post submersion of fluid
respiratory distress of lung post near drowning
Risks of near drowning
MR, MI, SCI, no floatation device, alcohol
Pathological event depends on:
duration and temp
duration: 4-6 mins brain can survive before damage
heart/lungs 30 mins
temp: colder decreases oxygen demands
Clinical picture of TBI
restrictive lung disease
seizures, ICP due to edema
altered mental status
disturbed sensory/motor/speech
Cognitive Clinical Picture of TBI
problems with:
communication
concentration
reasoning
judgement
attention
memory
Physical Clinical Picture of TBI
problems with:
speech vision hearing sensory decrease coordination headaches change in tone seizures
Social Clinical Picture of TBI
problems with:
fatigue
anxiety
depression
emotional instability
Immediate management of TBI
stabilize the spinal cord, protect from further injury
infection, nutrition, ICP (15-20 mmHG is normal)
determine severity, OHI or CHI
Complication associated with TBI
post TBI seizures hydrocephalus DVT heterotrophic ossification (ectopic bony formation) GI/GU dysarthria, ulcer, incontinence
Prognosis of TBI
individual based
cummulative effect of primary and secondary injury
long term physical impairment most commonly limits social integration (employment)
