Traumatic Brain Injury Flashcards
1
Q
Alteration of brain function secondary to an external force
A
TBI
2
Q
5 sources of TBI
A
Falls, MVA, Sport-related, Violence, Blast Injury
3
Q
Two classifications of TBI
A
Open head and Close head
4
Q
Classifications of TBI: Mild TBI
A
Close head
5
Q
Classifications of TBI: Skull is open and damaged dura mater
A
Open head
6
Q
Classifications of TBI: Most common
A
Close head
7
Q
Classifications of TBI: Penetrating
A
Open head
8
Q
Classifications of TBI: Skull remains intact
A
Close head
9
Q
Classifications of TBI: Severe TBI
A
Open head
10
Q
3 types of Primary Brain Injury
A
Diffuse Axonal Injury, Concussion, Contusion
11
Q
Primary Brain Injury secondary to high-velocity forces
A
Diffuse Axonal Injury
12
Q
Primary Brain Injury secondary to shaking of the brain
A
Concussion
13
Q
Primary Brain Injury secondary to low-velocity forces
A
Contusion
14
Q
DAI MOI
A
Acceleration-deceleration angular forces (MVA)
15
Q
Three sites of DAI
A
Corpus Callosum, Parasagittal white matter, Pons & midbrain
16
Q
DAI is responsible for _______?
A
Initial LOC and Coma
17
Q
Concussion is responsible for ________>
A
Alterations of consciousness
18
Q
It is a distinguishing feature of TBI
A
DAI
19
Q
The most common site of DAI
A
Corpus Callosum
20
Q
Two other names of Concussion
A
Mild TBI/Mild DAI
21
Q
Level of Consciousness: (+) visual tracking
A
Minimally Conscious State
22
Q
Level of Consciousness: (+) Ventilator support
A
Coma state
23
Q
Level of Consciousness: (+) Sleep-wake cycle
A
Vegetative state
24
Q
Level of Consciousness: Mildly depressed
A
Lethargy
25
Level of Consciousness: (+) Unresponsiveness
Stuporous
26
Level of Consciousness: (-) Sleep-wake cycle
Coma State
27
Level of Consciousness: (+) Reflex crying/smiling
Vegetative State
28
Level of Consciousness: Cannot be aroused but can be aroused briefly via vigorous repetitive sensory stimulus
Stuporous
29
Level of Consciousness: More depressed
Obtunded
30
Level of Consciousness: (+) Minimal evidence of self and environment awareness
Minimally Conscious State
31
Level of Consciousness: GCS 3-8
Coma State
32
Level of Consciousness: Can be fully aroused with little difficulty
Lethargy
33
Level of Consciousness: Cannot be fully aroused
Obtunded
34
What is the indicator to say that the patient is out of the coma?
If the patient resume following commands
35
How can you say that the patient is in a persistent vegetative state?
If they are in a vegetative state for >30 days and >1 year
36
Level of Consciousness: Decrease interest/drowsy
Obtunded
37
Two types of contusion
Coup injury and Countercoup injury
38
Contusion on opposite site of impact
Countercoup injury
39
Contusion at the site of impact
Coup injury
40
Two sites of Contusion
Inferior frontal lobe and anterior temporal lobe
41
What site of contusion will result in memory loss?
Anterior temporal lobe
42
What site of contusion will result in behavioral changes?
Inferior frontal lobe
43
Behavioral Change: Excited
Agitated
44
Behavioral Change: Quick
Impulsive
45
Behavioral Change: Moody
Irritable
46
Behavioral Change: Violent
Aggressive
47
Behavioral Change: Decrease interest
Apathy
48
The length of time from the injury up until the time in which the patient remembers a going event.
Post-traumatic amnesia
49
2 forms to assess Post-traumatic amnesia
Galveston Orientation Test (GOAT) and Orientation Lag Test
50
What form is used to assess severe TBI?
Orientation Lag Test (10)
51
What form is used to assess mild TBI?
Galveston Orientation Test (GOAT)
52
What is the normal score of the Galveston Orientation Test (GOAT)?
76-100
53
Three types of secondary brain injury
Hydrocephalus, Herniation, ICP & CPP
54
What is the adult communicating form of hydrocephalus?
Normal Pressure Hydrocephalus
55
What is the problem in Normal Pressure Hydrocephalus?
There is no absorption
56
Triad of Hydrocephalus
DIG: Dementia, Incontinence (urinary), Gait Ataxia
57
Intervention for Hydrocephalus
Shunting
58
What is the first to improve after shunting?
Gait Ataxia
59
Three types of herniation
Uncal, central, Tonsilar
60
Most common CN affected in Herniations?
CN 3
61
4 areas affected in the Uncal Herniation
Cerebral Peduncle, RAS, Oculomotor, PCA
62
2 areas affected in the Central Herniation
Midbrain & Pons, RAS
63
3 areas affected in the Tonsilar Herniation
Cerebellar Tonsil, RAS, Medulla Oblongata
64
If RAS is affected, what manifestation will come out?
Coma
65
If PCA is affected, what manifestation will come out?
Hemianopsia
66
If Midbrain & Pons is affected, what manifestation will come out?
Decerebrate Rigidity
67
If Cerebellar Tonsil is affected, what manifestation will come out?
Neck Pain
68
If Cerebral Peduncle is affected, what manifestation will come out?
Paresis
69
If Medulla Oblongata is affected, what manifestation will come out?
Alteration of HR, RR, BP
70
If the Oculomotor nerve is affected, what manifestation will come out?
Gaze palsy
71
If the Above midbrain is affected, what manifestation will come out?
Decorticate rigidity
72
What fracture affects CN 9-12?
Basilar skull fracture
73
What fracture affects CN 3, 4, 6?
Orbital fissure fracture
74
What fracture affects CN 5, 7, 8?
Temporal fracture
75
What fracture affects CN 2?
Optic canal fracture
76
What fracture affects CN 1?
Cribriform plate of ethmoid fracture
77
If CN 1 is affected, what manifestation will come out?
CSF Rhinorrhea
78
The normal amount of ICP
<20 mmHg
79
Four clinical manifestations associated with Increased ICP
Headache, vomiting, nausea, papilledema
80
Swelling of opting disc
Papilledema
81
What cranial nerve lesion that results in Papilledema?
CN 2
82
The medication used to decrease ICP
Diuretics (Mannitol)
83
According to Sullivan, what intervention can you do to the patient experiencing increasing ICP?
Elevate the head up to 30 degrees from supine
84
The formula for Cerebral Perfusion Pressure
CPP = MAP - ICP
85
The normal amount of CPP
>50 mmHg
86
The normal amount of MAP
60-110 mmHg
87
The formula for Mean Arterial Pressure
MAP = DBP + 1/3 PP
88
The formula for Pulse Pressure
PP = SBP - DBP
89
Mild TBI: LOC
0-30 min
90
Severe TBI: PTA
>7 days
91
Mild TBI: GCS
13-15
92
Moderate TBI: LOC
30 min - 1 day
93
Severe TBI: GCS
3-8
94
Moderate TBI: PTA
1-7 days
95
Severe TBI: LOC
>1 day
96
Moderate TBI: GCS
9-12
97
Mild TBI: PTA
0-1 day
98
GCS: EO to sound
3
99
GCS: EO to pressure
2
100
GCS: Verbal words
3
101
GCS: Verbal sound
2
102
GCS: Withdraws to pain
4
103
GCS: Localizes pain
5
104
GCS: Verbally confused
4
105
GCS: Decorticates
3
106
GCS: Decerebrates
2
107
Scale that assesses the reflex
Glasgow Liege Scale
108
Glasgow Liege Scale: 5
(+) Fronto-orbicular reflex
109
Glasgow Liege Scale: 1
(+) Oculocardiac Reflex
110
Glasgow Liege Scale: 4
(+) Vertical oculocephalic
111
Glasgow Liege Scale: 2
(+) Horizontal oculocephalic
112
Glasgow Liege Scale: 3
(+) Pupillary light reflex
113
Glasgow Liege Scale: 0
No reflex activity
114
Ommaya Scale: Patient not obeying the command
3
115
Ommaya Scale: Patient is not recording ongoing events
2
116
Ommaya Scale: Patient is in decerebrate rigidity
4
117
Ommaya Scale: Patient is oriented
1
118
Ommaya Scale: Patient is still talking and obeying commands
2
119
Ommaya Scale: Patient is not responding to stimulus correctly
4
120
Ommaya Scale: Patient is totally unresponsive
5
121
Ommaya Scale: Patient is recording ongoing events
1
122
Ommaya Scale: Patient is responding to stimulus correctly
3
123
Ommaya Scale: Patient is disoriented
2
124
Ommaya Scale: Patient is fully conscious
1
125
Glasgow outcome scale extended: Good Recovery
8-7
126
Glasgow outcome scale extended: Vegetative State
2
127
Glasgow outcome scale extended: Moderate Disability
6-5
128
Glasgow outcome scale extended: Death
1
129
Glasgow outcome scale extended: Severe Disability
4-3
130
Glasgow outcome scale extended: Assistance 24 hours per day
3
131
Glasgow outcome scale extended: Returned to the previous lifestyle completely
8
132
Glasgow outcome scale extended: Indep ADL but has not returned to the previous lifestyle
5
133
Glasgow outcome scale extended: Returned to the previous lifestyle with some problem
7
134
Glasgow outcome scale extended: Assistance 8 hours per day
4
135
Glasgow outcome scale extended: Returned to the previous lifestyle with modification
6
136
Criteria used to assess cognitive functions of TBI
Ranchos Los Amigos
137
RLA: 1
No Response
138
RLA: 3
Localized Response
139
RLA: 7
Automatic Appropriate
140
RLA: 9
Purposeful Appropriate with standby assistance upon request
141
RLA: 4
Confused-Agitated
142
RLA: 5
Confused-Inappropriate
143
RLA: 2
Generalized Response
144
RLA: 8
Purposeful Appropriate
145
RLA: 6
Confused-Appropriate
146
RLA: 10
Purposeful Appropriate with modified independence
147
RLA: Responses are related to stimulus
RLA 3: Localized Response
148
RLA: Responses are not related to stimulus
RLA 2: Generalized Response
149
RLA: Follow simple commands inconsistently
RLA 3: Localized Response
150
RLA: Follow simple commands fairly consistently
RLA 5: Confused-Inappropriate
151
RLA: Follow simple commands consistently
RLA 6: Confused Appropriate
152
RLA: (+) Bizzare Behavior
RLA 4: Confused-Agitated
153
RLA: (+) Goal-directed behavior
RLA 6: Confused-Appropriate
154
RLA: (+) Robot-like behavior
RLA 7: Automatic Appropriate
155
RLA: No learning is possible
RLA 5: Confused-Inappropriate
156
RLA: Carry-over of relearned task
RLA 6: Confused Appropriate
157
RLA: New learning at a decrease rate
RLA 7: Automatic Appropriate
158
RLA: New learning without supervision
RLA 8: Purposeful Appropriate
159
RLA: Response is physiologic body changes, limited, same, stereotypic
RLA 2: Generalized Response
160
RLA: (-) STM/LTM
RLA 4: Confused-Agitated
161
RLA: Impaired Judgement
RLA 7: Automatic Appropriate
162
RLA: Has environmental awareness
RLA 8: Purposeful Appropriate
163
RLA: Patient is in a heightened state of activity
RLA 4: Confused-Agitated
164
RLA: Non-agitated
RLA 5: Confused-Inappropriate
165
RLA: (+) Abstract Reasoning
RLA 8: Purposeful Appropriate
166
RLA: Patient is in deep sleep
RLA 1: No Response
