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PMPR 430 > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

What is the definition of Traumatic Brain Injury

A

A disruption in the normal function of the brain that can be caused by a bump. blow, or jolt to the head or a penetrating head injury

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2
Q

T/F: A concussion is a type of TBI

A

True

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3
Q

What are the three features for the Glasgow Coma Score/ what is the lowest and highest score

A

Eye opening, verbal response, best motor response/ 3 and 15 (CANNOT RECEIVE A ZERO)

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4
Q

What is considered a mild GSC score, moderate, severe

A

13-15: normal to lethargic with mild disorientation
9-12: Lethargic to obtunded, follows commands if aroused, confused
Less than or equal to 8: Doesn’t follow commands/ localizes pain and posturing

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5
Q

What are the two types of injury pertaining to TBI

A

Primary injury: Direct insult to the brain

Secondary: delayed- metabolic and biochemical changes

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6
Q

How is Cerebral perfusion pressure calculated (CPP), goal CPP, goal Intracranial pressure

A

MAP - ICP, 60-70 mmHg, less than 22 mmHg

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7
Q

What is the autoregulation to maintain constant cerebral blood flow (CBF), what occurs if there is low CBF AND a loss of autoregulation, what occurs if there’s high CBF and low autoregulation

A

Cerebral blood vessels can dilate or constrict to maintain constant CBF, cerebral ischemia, Increased ICP

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8
Q

What states would be treated pharmacologically for acute management of Severe TBI

A

Systemic hypotension, intracranial hypertension, coagulopathy management

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9
Q

What is the long term goal of therapy

A

REcovery or salvage of neurological function

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10
Q

What are the short term goals

A

Control intracranial hypertension: ICP less than 22 mmHg

Optimizing CPP: Goal of 60-70 mmHg

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11
Q

What is the goal blood pressure in a TBI patient, MAP

A

SBP greater than 100 mmHG (Age 50-69) or 110 mmHg (Age 15-49 OR greater than 70), 80-100

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12
Q

What fluid can be given for systemic hypotension, what if there is no response to the fluids, acute blood loss (greater than 30%)

A

Isotonic saline (0.9% NaCl): 1-2 liters, vasopressors: Norepinephrine, Packed red blood cells

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13
Q

In order to treat Intracranial hypertension (ICP greater than 22) what therapy is the best to use and what are the options of the therapy

A

Hyperosmolar therapy: Mannitol and Hypertonic saline

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14
Q

What is the MOA of hyperosmolar agents, additional effects

A

Mobilization of water from brain to vasculature through an osmotic gradient, reduces blood viscosity and decreases cerebral blood volume

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15
Q

How early can manitol be given and how fast does it work, what is the dose

A

Soon as the patient presents, within minutes, BOLUS of 0.25-1 g/Kg (continous infusion not recommended)

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16
Q

What are the adverse effects of mannitol

A

Diuresis leading volume contraction and hypotension, AKI due to increase in serum osmolality (mOSM greater than 320 gets NO MANNITOL), rebound increase in ICP since BBB is opened and there is mannitol accumulation

17
Q

What are 5 common hypertonic saline solutions indicated for prolonged intracranial hypertension, which is the ONLY one to be given PERIPHERAL

A

1.5%, 2%, 3%, 7.5%, 23.4%/ 1.5%

18
Q

What is the onset of hypertonic saline and duration REGARDLESS of concenctration

A

Rapid, 2-6 hours

19
Q

What are the adverse effects of hypertonic saline

A

Worsening hypernatremia (Threshold is Sodium greater than 160mEq/L), Central pontine myelinolysis/CPM (Serum Sodium should not raise greater than 0.5 mEq/L/hr, Worsening pulmonary edema

20
Q

What is another route of therapy for elevated ICP, how

A

Sedation and Analgesia: reduction in cerebral metabolic rate of oxygen (CMRO2) leading to a decrease in cerebral blood flow, cerebral blood volume, and intracranial volume

21
Q

What medications are inidicated for use in sedation of patients with TBI

A

Propofol (rapid onset and short duration), Midazolam or other BZDs (does not lower ICP), fentanyl or other opioids

22
Q

What is the last resort for reducting ICP if hyperosmolar therapy and sedation does not work, MOA

A

Barbituates: Pentobarbital, Reduction cerebral metabolic rate of oxygen causes a decrease in cerebral blood and cerebral blood volume lower ICP

23
Q

What is the loading dose, maintenance dose

A

10 mg/kg over 30 minutes THEN 5 mg/kg/hr for 3 hours/ 1 mg/kg/hr

24
Q

What is the goal serum concetration, adverse effects

A

30-40 mg/dL, hypotension (Keep CPP between 60 to 70)

25
Q

What should be done if ICP is stable by pentobarbital for 24 - 48 hours

A

Taper over 24 to 72 hours

26
Q

What norpharmacologic ways to lower the ICP

A

increase the head of the bed by 30 degrees (avoid hypotension), prophylatic hyperventilation after 24 hours(MUST BE SHORT TERM)

27
Q

T/F: Decompressive craniectomy is the number one way to reduce ICP

A

False: Bifrontal DC is not recommended to reduce ICP

28
Q

T/F: If a patient is taking anticoagulation medications they must be reversed if TBI is present

A

True

29
Q

What are seizure prophylatics for patients with TBI

A

Phenytoin or fosphenytoin within 7 days of injury, valproic acid (increased mortality), levetiracetam

30
Q

What is the loading dose for phentyoin given for seizure prophylaxis, usual maintenance dose, duration, therapeutic range

A

12-20 mg/kg (max infusion of 50mg/minute), 5-7 mg/kg/day, 7 days, Total: 10-12 mcg/ml with free at 1-2 mcg/ml

31
Q

What is the dosing for levetiracetam for seizure prophylaxis in patients with TBI

A

1000 mg IV every 12 hours

32
Q

What are the options for VTE prophylaxis

A

LMWH or low dose unfractionated heparin

33
Q

T/F: Feeding patients to attain basal caloric replacement by at least the 5th day and at most the 7th day post injury is recommended to decrease mortality

A

True

34
Q

How does methylphenidate used in TBI patients, beta-blockers

A

Improve memory and information processing, improve agitation and aggression

PMPR 430 (21 decks)

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