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Clin med II Patho > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

Incidence

A

3: 1 male
bimodal: <5 yo and 15-24 years old

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2
Q

Prevalence

A

mortality of MVA decreased due to increased safety of vehicles

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3
Q

Risk factors of TBI for >65 yo

A 
female
poor vision
dementia
history of falls
polypharmacy
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4
Q

Closed Headed Injury

A

Mass effect

non penetrating
acceleration/deceleration blow
ranges from minor to irreversible
brainstem white mattage shear force= damged CN,BV, CSF rhinnorhea

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5
Q

Open Headed injury

A

penetrating of meninges

acceleration/deceleration force

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6
Q

Fracture with head injury

A

increased risk for

meningitis
encephalitis
infection
abscess

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7
Q

Primary damage

A

contact moi, coup contra coup effect, local to site

non contact moi, shear force, diffuse

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8
Q

Secondary damage

A

hypoxic ischemia due to vascular insult an arterial hypoxemia

intracranial hematoa

increased cranial pressure/hydrocephalus

mass effect from edema

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9
Q

Cause of secondary damage

A

increased cranial pressure= dec cerebral perfusion

electrolytes imbalance

hypoxic/hypotension

neuro/celluar change

ischemia

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10
Q

pathogenesis of head injury

A

laceration to neural tissue
contusion forcing hematos
shear force with rotation
instantaneous rise if ICP above 40mmHg

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11
Q

Immediate complication

A

vasogenic edema (increased permeability with extracelluar fluid)

cytotoxic edema

CSF in steady state with extracelluar fluid

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12
Q

Glasgow Coma scale

A

eyes opening (1-4)
speech (1-5)
following of motor commands (1-6)

13-15=mild
9-12=mod
<8=severe

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13
Q

Mild head injury

A

concussion

uncomplicated, requires family to observe

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14
Q

Concussion definition/characteristics

A

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

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15
Q

Post concussive syndrome

A

rest is best treatment

HA, decrease memory, irratability, insomnia
s/s for weeks to months
limited ability to complete ADLs
controversial psychological/subjective

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16
Q

Acute epidural hemorrhage

A

no coma

no tx=neurological deterioration

17
Q

Acute subdural hemorrhage

A

if not resolve may lead to coma
needs surgery
bleeding stops due to ICP

18
Q

Chronic subdural hemorrhage

A

slow venous leaking
mistaken for tumor/mass
needs surgery
neurological deterioration

19
Q

Subarachnoid hemorrhage

A

treat like epidural

20
Q

Cerebral hemorrhage

A

disrupted cerebral circulation

manage similar to hypertensive strokes

21
Q

Severe head injuries in general

A 
LOC
multiple sites (SCI, ribs, eyes)
permanent deficits will persist
22
Q

Brain dead

A

if greater than 30mins

no response to stim/no reflexes (poor eeg <2microvolt)

ventilator needed (apenea)

can’t maintain homeostasis

23
Q

Persistent vegetable state

A

wakefull but decreased cerebral functioning

PVS long than 3 months=poor prognosis

primitive reflex

24
Q

Near drowning Incidence and Definition

A

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

25
Q

Risks of near drowning

A

MR, MI, SCI, no floatation device, alcohol

26
Q

Pathological event depends on:

A

duration and temp

duration: 4-6 mins brain can survive before damage
heart/lungs 30 mins

temp: colder decreases oxygen demands

27
Q

Clinical picture of TBI

A

restrictive lung disease
seizures, ICP due to edema
altered mental status
disturbed sensory/motor/speech

28
Q

Cognitive Clinical Picture of TBI

A

problems with:

communication
concentration

reasoning
judgement
attention
memory

29
Q

Physical Clinical Picture of TBI

A

problems with:

speech
vision
hearing
sensory
decrease coordination
headaches
change in tone
seizures
30
Q

Social Clinical Picture of TBI

A

problems with:

fatigue
anxiety
depression
emotional instability

31
Q

Immediate management of TBI

A

stabilize the spinal cord, protect from further injury
infection, nutrition, ICP (15-20 mmHG is normal)
determine severity, OHI or CHI

32
Q

Complication associated with TBI

A 
post TBI seizures
hydrocephalus
DVT
heterotrophic ossification (ectopic bony formation)
GI/GU dysarthria, ulcer, incontinence
33
Q

Prognosis of TBI

A

individual based

cummulative effect of primary and secondary injury

long term physical impairment most commonly limits social integration (employment)

Clin med II Patho (11 decks)

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