Traumatic Brain Injury II Flashcards
Coma
A deep state of unconsciousness where a person does not consciously respond to external stimuli (an altered state of conscious)
Coma can be brief or last for weeks at a time
Occurs secondary to an underlying neurological condition or traumatic brain injury
Characteristics:
- no eye opening
- no communication
- no following directions
- no purposeful movement
Vegetative State
Patient has lost cognitive abilities and awareness of surroundings; will maintain normal sleep-wake cycles
Spontaneous movements may occur and even include crying, laughing, or grimacing; Patients may open their eyes to external stimuli (not purposeful)
Vegetative State → Persistent Vegetative State @ 1
Characteristics:
- unconsciousness
- no communication
- no following directions
- no purposeful movements
Minimally Conscious State
MCS references those Patients that exhibit a slow recovery of consciousness; continue to have poor self-awareness as well as awareness of the world around them
Patients may intermittently follow directions; communicate y/n via gestures or vocalizations; may use some recognizable words + phrases
May reach for objects or try to hold an object; focus on items or people for longer periods of time
Patients are very inconsistent
Powerpoint
Look at chart and timeline for consciousness
Glasgow Coma Scale (look at powerpoint)
Teasdale and Jennette in 1974, 1976
Estimation of the depth of coma as a measure of severity within the first 24h of the trauma
Patient is assigned a score between 3-15; points are assigned per BEST eye opening (1-4), BEST motor response (1-6), and BEST verbal response (1-5); the > the score the more conscious the person
-Adult and Modified Pediatric Version
Mild TBI= Total score between 13-15
Moderate TBI= Total score between 9-12
Severe TBI= Total score <8
Decorticate Flexion Posturing
(look at pic)
-results from damage to one or both corticospinal tracts
- arms are adducted and flexed
- wrists and fingers flexed on chest
- legs are stiffly extended and internally rotated
- feet plantar flexion
Decerebrate Extension Posturing
(look at pic)
-results from damage to the upper brain stem
- arms are adducted and extended
- wrists pronated and fingers flexed
- legs stiffly extended
- feet planter flexion
PTA
- may be used as an alternative to the GCS
- References the period to time where the Patient has regained consciousness but is still in a disoriented and confused state and until the time the Patient’s memory for ongoing events becomes reliable and accurate
Mild TBI: period of coma + PTA < 1h
Moderate TBI: period of coma + PTA 1-24h
Severe TBI: period of coma + PTA 1-7 days
Profound TBI: period of coma + PTA 7+days
Response Progression
Patients may progress through several types of responses during recovery from a state of altered consciousness
Deepest Stage Reflexive Behaviors Generalized Responses Localized Responses Physiological Responses
Deepest Stage
Patient is totally unresponsive to any stimuli including painful or aversive types (noxious stimuli(smell))
Reflexive Behaviors
Patient exhibits production of unconscious, subcortical reflexive behaviors; may return to primitive behaviors (early reflexive ex. munching) (Hux, p. 82-83)
Generalized Response
Stimulation triggers movement of a body part not associated with the actual stimulus; a noise in the room may trigger a chewing response
Localized Responses
Noise occurs in the room, Patient turns toward stimulus
Physiological Responses
Stimulus triggers change in BP, RR, O2, Temp, Pupils (change in the pt. body)
Ranchos Scale
The RLAS provides a way to describe cognitive functioning from the early stage of injury through to the later stages of recovery
Patient is assigned a level based on their presentation using # 1-X
Levels I-III (severe deficits)
Levels IV-VI (moderate deficits)
Levels VII-X (milder deficits)
Ranchos Scale (three groups)
Levels (I-III): Patients present as comatose or emerging from a coma; may be categorized as in a persistent vegetative state or minimally conscious state
Levels (IV-VI): Patients present as beginning the process or regaining orientation + memory skills necessary for full consciousness
Levels (VII-X): Patients present with persistent cognitive, social, and emotional challenges
Ranchos I
No Response
Unresponsive to any stimuli
Comatose
Ranchos II
Generalized Response
Non-purposeful responses
Usually to pain only
Ranchos III
Localized Response
Purposeful
May follow simple commands
Ranchos IV
Agitated/Confused
Confused; Disoriented
Agitated: Aggressive; Combative
Unable to perform self-care
Ranchos V
Confused/Inappropriate
Non-Agitated Verbally inappropriate Does not learn Responds to commands Appears alert
Ranchos VI
Confused/Appropriate
Can relearn old skills
Serious memory deficits
Some awareness of others and self
Ranchos VII
Automatic/Appropriate
Oriented
Minimal confusion
Robot-like ADLs
Lacks insight into planning ability
Ranchos VIII
Purposeful/Appropriate
A&O Independent in living skills Capable of driving Deficits may persist for judgment Skills not premorbid
