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intro to TBI
neuromuscular
| Question | Answer |
|---|---|
| What are the primary risk factors of TBIs? | age, gender (males>females), socioeconomic status and exposure to alcohol or high impact activity |
| What are the three parts of the Glasgow Coma Scale ? | Eye opening, Motor response, Verbal response |
| What do results of 3-8 on the GCS mean? | severe injury |
| What do results of 9-12 on the GCS mean? | moderate injury |
| What do results of 13-15 on the GCS mean? | mild injury |
| What are the primary prognosticators of TBI? | GCS score, post traumatic amnesia, time unconscious, Intracranial pressure (ICP), hemorrhage, fracture or combination of above |
| What are the two primary types of injury? | open head injury, closed head injury |
| What is considered an open head injury? | Skull is fractured all the way through the bone |
| what is considered a closed head injury? What might these injuries lead to? | acceleration-deceleration causes a diffuse axonal injury; atraumatic vascular injury leading to hypoxia, edema or even cell death; hypoxic injury caused by the lack of O2 in the brain which may be due to blocked airway or vessel damage |
| What are the 4 types of secondary damage to the two types of head injury? | increased ICP causing shift in brain tissue or herniation, electrolyte imbalance causes swelling or rupture to cells/membranes; seizures, and infections |
| What are the three types of radiological evaluation? | CT, MRI and EEG |
| When is a CT indicated for TBI? | always for a fracture, if GCS is below 15 for >24 hours, good for detecting hematomas, hemorrhage, edema, infarct, midline shift and ventrical size |
| What is true about MRI compared to CT? | MRI shows brain structures in more detail, although it is not as available as CT |
| What is an EEG used for? | detecting brain activity if questionable; a radiologist looks for specific brainwave patterns |
| What are normal and abnormal ICP values? | normal: 1-10 mmHg; >20: concerning, abnormal, change position; >40: impairment of electrical activity; >60: may be fatal |
| What are the surgical procedures for TBI? | Craniotomy for swelling and compression of the brain, debridement or removal of bone fragments to prevent infection, insertion, insertion of a monitor for ICP |
| What might a fever indicate? | potential DVT or pulmonary embolism, potential heterotopic ossification |
| What is the intervention for heterotopic ossification? | surgical removal of the excess bone after it has "matured" (i.e stopped increasing in size) |
| What are the four states of consciousness? | coma, persistent vegetative state, minimally conscious/severely altered consciousness, Locked-in syndrome |
| What state of consciousness is defined as; unresponsive to any and all stimuli with no spontaneous motor activity? | coma |
| What state of consciousness is defined as; intermittent opening of the eyes with few responses, used after a year post injury? | persistent vegetative state |
| What state of consciousness is defined as; pt has some awareness and response to the environment although they are not specific to stimuli? | minimally conscious; severely altered consciousness |
| What state of consciousness is defined as; pt is only able to move their eyes, they are cognitively intact? | Locked-in syndrome |
| What are the 4 primary cognitive complications after TBI? | personality change, memory loss, emotional lability, lack if initiative |
| What are the cardiovascular risks after a TBI? | cardiac, thromboembolism, pulmonary embolus |
| What are the treatments for the cardiovascular risks? | compression stockings, intermittent pneumatic compression, pharmacological intervention, vena cava filter to catch any clot coming from the LEs |
| What is Hyponatremia? | syndrome of excess ADH, not enough sodium/salt. |
| What are the symptoms of hyponatremia? | nausea, vomiting, malaise, headache, mm cramps, lethargy, irritability, seizures, coma, confusion |
| What might cause hyponatremia? | drinking too much water, medications such as; chemotherapy, anti-seizure meds, oral anti-inflammatories |
| What is Hypernatremia? | high concentration of salt in the body |
| What are the symptoms associated with hypernatremia? | thirst, postural hypotension, malaise, headache, confusion, abnormal speech, irritability, seizures, myoclonic jerks, coma |
| What are the causes of Hypernatremia? | water loss, dehydration, diabetes insipidus, medications, impaired cognition |
Created by:
mcush1
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