Acute Brain Injury

Question 1

what are some causes of non-traumatic brain injury?

Answer 1

tumors, vascular causes such as CVA, cerebral anoxia cardiac arrest, toxic poisoning or OD, metabolic or hepatic encephalopathy, infection meningitis

Question 2

what are some traumatic causes of brain injury?

Answer 2

• concussions (mild brain injury)
• diffuse axonal injury (DAI, often end up in vegetative state)
• hematomas (epidural, subdural, intracranial (most common))

Question 3

what causes an increase ICP?

Answer 3

Cerebral edema
hemorrhage
biochemical response and infection

leading to compression of brain tissue

Question 4

what is the most common way to monitor ICP?

Answer 4

intraventricular catheter/extraventricular drain (EVD) (SYSTEM MUST BE LEVELED WITH INSERTION SITE INTO PATIENT; also used to drain CSF to control ICP)

Question 5

what is a normal ICP level?

Answer 5

10-15 mmHg

Question 6

An ICP level of _____causes brain death

Answer 6

> 40 mmHg for 4hrs

Question 7

what happens when Cerebral Perfusion Ratio is <70-100 mmHg?

Answer 7

decreased oxygenation to cerebral tissue

Question 8

Mean Arterial Pressure (MAP) must be above___mmHg to maintain adequate CPP

Answer 8

90

Question 9

Surgical management of acute brain injury includes?

Answer 9

burr holes
craniotomy
bone flap removal

Question 10

what are some precautions and contraindications after bone flap removal?

Answer 10

NEVER turn to affected side
Pt not allowed to put pressure over the area

Only tilt to affected side or buffer head with foam
May require helmet during mobilization

Question 11

what can raise ICP?

Answer 11

• Head movement
• Coughing
• Suction: respiratory depression–>increases arterial CO2–>causes vasodilation increasing bloodflow–> increases ICP (monitor carefully)

Question 12

For ICP control always…….

Answer 12

• consult for mobility and positioning orders
• request bolus of sedation during Rx
• maintain HOB at 30 degrees
• move pt slowly
• -if EVD in situ close stopcock before altering HOB or mobilizing
• turn pt every 2 hours, maintain head in neutral position

Question 13

decorticate posture

Answer 13

arms flexed

legs extended

Question 14

decerebrate posture

Answer 14

extensor tone in UE and LE

Question 15

what are some effects of extended positioning?

Answer 15

thinning of cartilage, atrophy of muscles and weakness, reduced joint lubrication

Question 16

PT management to prevent contractures

Answer 16

Place muscles in lengthened position for enough time
-20min to 12 hours a day

Splinting and casting to maintain ROM
-resting splints 6-8 hrs at least , preferred overnight

PROM with joint approximation and touch – to maintain body schema and awareness

Question 17

what decreases ICP?

Answer 17

hyperventilation –decreases pressure and therefore ICP, but also causes hypoxia so short term fix

Question 18

what does a low INR (international normalized ratio) mean? normal is 0.9-1.3

Answer 18

decreased coagulation of blood, reduced ability to heal

restricted activity and on bed rest

Question 19

INR 2-3

Answer 19

patient on warfarin