Traumatic brain injury Flashcards
What are primary and secondary injuries in TBI?
Primary injury occurs immediately upon impact. Occurs from linear or rotational forces. Examples include skull fracture, contusion, subarachnoid hemorrhage, and mechanical injury. Focal injury is most common in frontal and temporal lobes, due to anatomical arrangement of the brain and skull. Diffuse axonal injury is most common at the gray-white matter junction.
Secondary injury is the aftermath after injury. Examples include hypoxia, ischemia, swelling/edema, hypotension, mass lesions, raised ICP, and poor cerebral perfusion pressure. Can be gradual or accelerate quickly if not managed (such as increased ICP causing brain herniation and death).
What are risk factors for TBI?
1) Age (0-4 - due to child abuse), 15-19 (MVAs), and 65+ (falls).
2) Alcohol/substance use, male gender, psych illness, ADHD, lower SES
What are risk factors for increasing persistent problems after mild TBI (after 3 months post injury)?
1) prior hx of neurological injury
2) multiple TBIs
3) hx of chronic medical condition
4) polytrauma/chronic pain
5) misattribution bias
6) potential for secondary gain
7) hx of psychopathology (depression, anxiety, subs use)
What percentage of TBIs are mTBI?
80%
Who is at risk for developing subdural hematoma?
Ppl aged 60+… due to widening of the cortical sulci with aging and thus increased bridging vein vulnerability.
What info do you need to assess brain injury severity?
Info from the acute severity period:
1) Glasgow coma scale (GCS)
2) time to follow commands (TFC)
3) length of post traumatic amnesia (PTA)
What kinds of things can make it difficult to assess brain injury severity?
Intoxication, medications, substance withdrawal, infection, etc.
How long is PTA for ppl with mod to severe TBI?
Days to months post injury.
How do you treat TBI?
1) Medical stabilization overall and perhaps emergent surgical intervention (to reduce ICP)
2) Maintaining a low stim environment and a predictable routine.
3) Avoiding use of neuroleptics and anticonvulsants due to neg effect on cognition.
When should you do a NP assessment for mod to severe TBI?
After the patient demonstrates a measurable level of continuous memory for 2-3 consecutive days.
What should NP assessment focus on for TBI patients?
Not just weaknesses.
Important to focus on
1) need for supervision/guardianship/conservatorship/attendant care
2) restrictions or accommodations for school, work, driving etc.
3) need for psychological and behavioral intervention
What is the recovery timeline for mod to severe TBI?
Recovery may take more than 12 months, but most of recovery is within a few months after injury. Usually social support and access to resources tend to have more influence on functional recovery than injury severity.
Which domains are most commonly affected in mod to severe TBI?
Attention, multitasking, processing speed, memory, executive functions (organization, planning, mental flexibility, and judgment), and emotional regulation. Exec function problems are common due to high probability of injury to the frontal systems. These problems can be a critical barrier to functional recovery. More difficult to determine are a TBI’s effect on frustration tolerance, personality, social skills, social judgment, humor, etc. Frontal injury can also lead to psychological px that may look like OCD, bipolar, etc.
What is acceleration/deceleration injury?
These occur following unrestricted movement of the head creating tensile, shear, and compressive strains that follow high speed events.
What is the GCS and its ratings?
Assesses responsiveness in patients who sustained TBI. There are 3 parameters: eye opening, motor response, and verbal response. The scale ranges from 3-15.
Scores less than 8 = severe injury
scores over 13 = mild injury
GCS 3 to 5 are associated with increased mortality.
