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PT 862 > Overview of TBI > Flashcards

Overview of TBI Flashcards

1
Q

What is an Acquired Brain Injury (ABI)

A

Not hereditary, congenital, degenerative, or induced by birth trauma

Results in changes in neuronal activity affecting the physical integrity, metabolic activity, or functional ability of neurons

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2
Q

What is a Traumatic Brain Injury (TBI)?

A

Injury caused by external forces

Impact to the head directly (traumatic impact)
Inertial forces that damage the brain (traumatic inertial)

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3
Q

What is a Nontraumatic Brain Injury (NTBI)?

A

Caused by internal factors

Examples (Anoxia/hypoxia, Exposure to toxins, Infections, Pressure from tumor, Stroke)

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4
Q

What are the two types of TBIs?

A

Traumatic IMPACT: Impact to the head directly
Traumatic INERTIAL: Inertial forces that damage the brain

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5
Q

How many (around about) ED visits are related to TBI-related causes?

A

2.8 million in on year (56,800 deaths)
Increased 54% in 8 years

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6
Q

What are the top 3 causes of TBI related injuries?

A

1: falls (48%): most are children and older adults

Intentional self-harm was the second leading cause of TBI-related deaths alone (33%)—leading cause for ages 45–64 years old

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7
Q

Who is at highest risk to get a TBI and be hospitalized?

A

American Indian/Alaska Native

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8
Q

Who is at highest risk to not get follow up care?

A

Racial and ethnic minority groups (non-Hispanic black and Hispanic)
Poorer psychosocial, functional, and employment outcomes

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9
Q

Who has the worst outcome related to TBIs?

A

Persons in correctional facilities, those who are homeless, survivors of partner violence, service members/veterans, persons with lower incomes/health insurance, rural

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10
Q

What are some risk factors for TBI?

A

Younger (0–4, 15–19) or elderly (75 and older)
Male
Lower SES
Psychiatric diagnosis
Dementia
Contact sports, not using helmets

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11
Q

What are the five criteria to classify injury severity?

A

Structural Imaging
Loss of consciousness
Alteration of Consciousness/mental state
Post-traumatic amnesia
Glasgow coma scale

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12
Q

What are the TBI serverities?

A

Mild (minutes to hours)
Moderate (minutes to days)
Severe (hours to days)

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13
Q

What is Posttraumatic Amnesia (PTA)?

A

A period of disorientation and difficulty consistently making new memories

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14
Q

What is considered the resolution of PTA?

A

Consistently oriented and able to make new memories

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15
Q

What are the components of the Glasgow Coma Scale?

A

Eye opening (1-4)
Motor Response (1-6)
Verbal Response (1-5)

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16
Q

Is a higher score on the Glasgow Coma Scale good or bad?

A

Good! Highest score is 15
Lowest score possible is 3 and is the worst

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17
Q

What are some posturing examples?

A

Decorticate: Elbow and wrist flexion, toe/ankle extension

Decerebrate: Elbow extension and wrist flexion, toe/ankle extension
(cErEb - Elbow Extension)

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18
Q

Can posturing be one sided?

A

Yes!
Associated with one hemisphere compression

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19
Q

What is the cause of decorticate posturing?

A

Bilateral damage to diencephalon-upper midbrain

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20
Q

What is the cause of decerebrate posturing?

A

Bilateral damage to upper midbrain

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21
Q

What if someone is presenting with no upper extremity movement and there’s a Babinski response at the toes on the same side?

A

one entire hemisphere compression ofdiencephalon

22
Q

Pre-existing factors that can interfere with GCS?

A

Language or cultural differences
Intellectual or neurological deficit
Hearing loss or motor speech impairments

23
Q

What are some effects of current treatment that can interfere with GCS?

A

Physical (e.g., intubation or tracheostomy)
Pharmacological (e.g., sedation or paralysis0

24
Q

What are some effects of other injuries or lesion that can interfere with GCS?

A

Orbital/cranial fracture
Aphasia or hemiplegia
Spinal cord damage

25
Q

Describe raccoons eyes

A

Brusing and swelling of eyes

Periorbital ecchymosis

Basilar skull fracture, more anterior

26
Q

Describe battle’s signs

A

Bruising around mastoid/ears

Retroauricular ecchymosis

Basilar skull fracture, more posterior

27
Q

How is a mTBI defined by the American Congress of Rehabilitation Medicine

A

Traumatically induced physiological disruption of brain function, as manifested by at least one of the following:

  1. Any period of loss of consciousness
  2. Any loss of memory for events immediately before or after the accident
  3. Any alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused)
  4. Focal neurological deficit(s) that may or may not be transient, but where the severity of the injury does not exceed the following: Loss of consciousness of approximately 30 minutes or less. After 30 minutes, an initial Glasgow Coma Scale (GCS) of 13–15, Posttraumatic amnesia (PTA) not greater than 24 hours
28
Q

What are the causes/pathophysiologies for primary injury

A

Axonal shearing (diffuse axonal injury)
Contusion
Epidural hematoma (EDH)
Subdural hematoma (SDH)
Subarachnoid hemorrhage (SAH)
Hypoxic-ischemic

29
Q

What is a Coup-Contrecoup injury?

A

Coup is the initial injury
Contrecoup is the secondary injury/impact
Brain occurring injury at front and back as it moves in the skull

30
Q

What is a diffuse axonal injury?

A

Widespread shearing and retraction of damaged axons
Sudden acceleration then deceleration of brain
Shaken baby syndrome
Result of to Coup-Contrecoup

Causes from gray and white matter having different levels of stiffness

31
Q

What is a Contusion?

A

Bruise on the brain
Result of to Coup-Contrecoup

32
Q

What is a Epidural hematoma (EDH) and how does it present?

A

Collection of blood between dura and cranium

Brief loss of consciousness followed by lucid interval, then headache, obtunded, hemiparesis - can be deadly

33
Q

What is a Subdural hematoma (SDH) and how does it present?

A

Collection of blood between the dura mater and arachnoid mater

Headache, altered mental status, hemiparesis

Can cause a midline shift

34
Q

Major differences between SDH and EDH

A

Blood flow!
EDH - Artery (rapidly expanding)
SDH - Venous blood (slowly expanding)

35
Q

What is a Subarachnoid Hemorrhage (SAH) and how does it present?

A

Bleeding into subarachnoid space

Often seen with aneurysms, but can be caused by TBI

36
Q

What is a Subarachnoid Hemorrhage (SAH) and how does it present?

A

NTBI
Systemic hypotension
- Result of Anoxia/hypoxia
- Results in Global damage

37
Q

What are some secondary injuries/pathophysiology associated with TBIs?

A

Cerebral herniation
Ischemic CVA from vascular compression
Excitotoxicity
Apoptosis - cell death
Inflammation due to trauma
Coagulopathy - clotting factors reduced for the brain while moving to other injury

38
Q

What is Intracranial Pressure (ICP) and how does it impact patients?

A

Increased intracranial pressure
- Abnormality of brain fluid dynamics
- Hematoma

Normal ICP is 4–15 mm Hg
>20mm Hg is enough to alert staff
Monitored with Licox

if increased, herniation of brain
- Supratentorial: uncal, central, cingulate, transcalvarial, tectal
- Infratentorial: upward cerebellar/transtentorial,
tonsillar/downward cerebellar

External Ventricular Drain for fluid management (can be clamped for movement)

39
Q

What is the primary goal for managing an acute TBI?

A

Prevent secondary injury by surgical management
Intracranial pressure (ICP) monitoring
Cardiovascular/respiratory support
Management of concomitant injuries

Additional: reverse coagulopathy, DVT/PE prevention, EARLY MOBILIZATION, nutrition

40
Q

When would surgical intervention be warrented?

A

Reduce depressed skull fracture
Remove penetrating bodies if accessible
EDH/SDH
- Craniotomy/craniectomy (Cryopreservation or subcutaneous storage followed by cranioplasty)
- Burr hole/catheter

41
Q

Name some red flags for TBI management

A

Progressively declining level of consciousness
Progressively declining neurological examination (neurocognitive, neurobehavioral)
Pupillary asymmetry
Seizures
Repeated vomiting
Double vision
Worsening headaches
Cannot recognize people or disoriented to place
Behaves unusually or seems confused and irritable
Slurred speech
Unsteady on feet
Weakness or numbness in arms/legs

42
Q

What are some biomedical complications that can occur?

A

Include but not limited to:
-Seizures
- Sympathetic “storming”
- Hydrocephalus
- Heterotopic ossification (inflammation reaction)
- Venous thromboembolism (DVT, PE)

43
Q

Describe Seizures

A

Electrical disturbance in the brain

Risk factors: hydrocephalus, intracranial hemorrhage, depressed skull fracture, hematoma evacuations, low GCS, dural penetration, parietal lesions, focal neuro deficits

Multiple types (e.g., generalized with impaired awareness, focal awareness)

May be “subclinical” (may not even know they are occurring)

44
Q

Describe sympathetic “storming”

A

Also known as paroxysmal sympathetic hyperactivity (PSH), dysautonomia

Uninhibited sympathetic outflow after CNS injury

Cycling of agitation/dystonia
- Tachycardia, tachypnea, hypertension, hyperthermia, diaphoresis/hyperhidrosis, posturing
- Diagnostic PSH-AM scal

45
Q

Describe Hydrocephalus

A

CSF accumulation in the ventricles (brain swelling that can lead to brain herniation)

May note the following:
- Papilledema: pressure causes optic nerve swelling
- Decreased consciousness
- Memory deficits
- Headache
- Focal neurological deficits

46
Q

What are the domains within the constellation of impairments?

A

Physical: abnormal tone, sensory deficits, decreased motor control/learning, paresis/paralysis, impaired balance, spasticity, etc.
Behavioral
Emotional
Cognitive

47
Q

What are some ways to measure/describe BI recovery/progress?

A

Rancho Los Amigos Levels of Cognitive Functioning (LOCF)
Disability Rating Scale (DRS)
Glasgow Outcome Scale: Extended

48
Q

How main levels are within the LOCF?

A

8 or 10 levels
Levels of assistance are included on 10 level

Lower the level: more assistance and decreased response

49
Q

When does the DRS get administered? and what is included?

A

Administered within 72 hours after rehab admission and within 72 hours before discharge
Eye-opening communication ability, motor response, cognitive ability for feeding, toileting, and grooming, as well as level of functioning for physical, mental, emotional, or social function, and employability

50
Q

When does the Glasgow Outcome Scale: Extended get administered? and what is included?

A

Administered at 3, 6, and 12-month marks
Consciousness, independence inside and outside of home, social and leisure activities, family and friendships

PT 862 (13 decks)

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