Cognitive Lecture 1 Flashcards
(94 cards)
1
Q
What is a sign?
A
What the examiner finds upon examination
2
Q
What is a symptom?
A
What the patient reports
3
Q
What does “sp” (s/p) mean?
A
Status post (sp appendectomy: seeing them after appendectomy)
4
Q
What does SOA mean?
A
short of air
5
Q
What is the definition of TBI?
A
an insult or injury to the brain, not of degenerative or congenital nature but is caused by an external force that may produce (has to result in) diminished or altered state of consciousness; if you’re dazed/nauseous, it’s still mild
6
Q
mTBI
A
mild traumatic brain injury
7
Q
How many brain injuries occur annually
A
1.5 to 1.9 million
8
Q
TBIs are the #1 cause of death in…
A
children and young adults (there’s a lot of growing left to do–long-term effects)
9
Q
Demographic variables that determine risk factors for TBI
A
Age, SES, ethnicity, gender, substance abuse, recurrent TBI
10
Q
Myelin & neural connections are still forming until age ___
A
25
11
Q
Age range of increased risk of TBI
A
15-24 years old
12
Q
Gender at greater risk of TBI
A
males (2:1)
13
Q
Race and TBI
A
too variable for determination in USA
14
Q
High Alcohol & TBI
A
1 study found that 56% of TBI patients had this
15
Q
Risk for recurrent TBI for second TBI (chance of having another if you’ve already had 1)
A
2.8-3.0 times more likely
16
Q
Risk for recurrent TBI for third TBI (chance of having another if you’ve already had 2)
A
7.8-9.3 times more likely
17
Q
Closed Head Injury (CHI)
A
Non-penetrating injury-no penetration to cranial vault; Blunt head trauma
Meninges remain intact; Skull may be fractured
Associated with diffuse injury; more common type of injury
18
Q
Open Head Injury (OHI)
A
Penetrating injury-brain is exposed
Military more susceptible
Coverings of brain susceptible to tearing of the dura by skull fragments &/or other penetrating force
Associated with focal injury; more common in wartime
19
Q
Overall most common cause of TBI
A
Falls
20
Q
MVAs and TBIs
A
account for about 50% in ages 15-24 years old
21
Q
Brain Injury in KY
A
Affects 1 in 5 households; rate is more than twice the national avg
22
Q
How many ED visits are accounted for by BI
A
1/3
23
Q
A child’s skull is _____ as strong as an adult’s
A
1/8
24
Q
State with highest number of ATV fatalities
A
Kentucky
25
Leading cause of sports-related deaths
Brain injury
26
65% of all sports-related BI treated annually occurs in people between ages...
5 and 18 years
27
Activities associated with the greatest number of ED visits annually
bicycling, football, playground activities, basketball, horseback riding, & riding ATVs
Estimated that less than 13% of sports-related BI are seen in the ED
28
Concussion Rates
on the rise among high school athletes with females sustaining a greater number than males in sports played by both sexes
29
Primary Brain Damage
Damage that is complete at the time of impact
Skull fracture, contusion (bruise), hematoma (blood clot), laceration, nerve damage (DAI)
Part(s) of the brain damaged are greater than the size of the overall injury
30
DAI
diffuse axonal injury
31
Secondary Brain Damage
Things that develop after the initial traumatic event
Edema, increased ICP, infection, fever (febrile), anemia, epilepsy, hypo/ hyperthermia, abnormal blood coagulation, cardiac changes, pulmonary changes, nutritional changes, other results
32
Edema
swelling
33
ICP
intracranial pressure
34
Fever indicates...
infection (body is trying to fight it)
35
Anemia
iron deficiency
36
Hypo/hyperthermia
lose ability to regulate body temperature
37
ABC
abnormal blood coagulation: body either makes blood too thick or not thick enough (risk for stroke)
38
Classic Closed Head Injury
BI that occurs secondary to impact to the head causing deformation of the brain resulting in characteristic pathological changes
MVAs, assault, suicides, falling objects, & falls
Leading cause of death under age 45 years
Accounts for 25-33% of all deaths related to trauma
Coup/contra-coup
39
Coup/contracoup injuries
brain acceleration vs. deceleration
40
Penetrating Head Injury
Less common than CHI
Occurs secondary to penetration of an object like a: bullet, knife, bolt, shrapnel, nails, teeth, screwdriver, etc.
Often described as: depressed, penetrating, perforating
Mortality rate appears lower for AP (anterior-posterior) wounds (25%) than lateral wounds (83%)
41
Depressed Penetrating Head Injury
Object doesn't enter cranial vault but causes a depressed fracture & cortical contusions
42
Penetrating-type head injury
Object enters the cranial cavity but doesn't pass through to the other side
43
Perforating-type head injury
Object traverses the cranial cavity & exits through a wound characteristically larger than the entry wound
44
Because of the recent wars, the US is now treating...
more TBIs than chest or abdominal wounds
45
Combat forces at risk for TBI
as many as 1/3
46
Ratio of Wounded to fatalities between Iraq/Afghanistan & Vietnam
Iraq/Afghanistan: 16:1
| Vietnam: 2.6:1
47
TBI and PTSD
separate but are co-related
48
Blast Injury
Explosion resulting in over-pressurization related trauma
49
Blast-induced BI is most frequently associated with
high-power explosives
50
Four (+) basic mechanisms of blast injury:
primary, secondary, tertiary, quaternary (quinary & psychological trauma (PTSD)
51
Primary Blast Injury
occurs secondary to over-pressurization impulse created by a detonated high- explosive usually impacting auditory, GI, &/or pulmonary systems (rupture of TM, abdominal cavity)
52
Secondary Blast Injury
Injuries that occur secondary to flying objects (rocks, shrapnel)
53
Tertiary Blast Injury
Injury sustained due to person becoming airborne (picked up by pressure wave)
54
Quaternary Blast Injury
References burns & crushing injuries from falling objects
55
Quinary Blast Injury
chemical, biological, &/or radiological exposure
56
Explosives
classified as either high-order or low-order
57
High-order Explosives (HE)
dynamite, ammonium nitrate
58
Low-order Explosives (LE)
result in shrapnel-like injuries
59
Improvised Explosive Device (IED)
Contain both HE, LE
60
Concussion
Injury to the brain that is loosely defined as a "jarring" of the brain; at the least are said to have a mTBI
Most common type of TBI
Frequently occurs secondary to violent shaking, direct blow to head, whiplash
61
Grade 1 Concussion
no LOC; PTA less than 30 minutes
62
Grade 2 Concussion
LOC less than 5 minutes; PTA between 30 minutes & less than 24 hours
63
Grade 3 Concussion
LOC greater than 5 minutes; PTA greater than 24 hours
64
PTA
post-traumatic amnesia
65
Pyramidal System
responsible for volitional motor control; direct activation pathways
66
Extrapyramidal System
Responsible for modulating & regulating motor movements; indirect activation pathways
67
Cerebellum
Does not initiate movement, rather it works in tandem with the EPS to maintain balance/posture & coordination of motor movements; includes motor learning
68
Dementia Pugilistica
aka punch-drunk syndrome or chronic traumatic encephalopathy
Occurs secondary to repeated concussive blows to the head
Can only be diagnosed in autopsy
Common in football players too
69
Dementia Pugilistica & Boxing
Estimated that 10-25% of boxers ultimately develop post-boxing neurological syndrome characterized by cerebral atrophy, cellular loss in the cerebellum, & increased cortical & subcortical neurofibrillary tangles
S/s may begin to appear 12-16y post initiation of career
Occurs in professionals & amateurs
70
Stages of Dementia Pugilistica
3 stages
71
Stage 1 of Dementia Pugilistica
affective disorder, mild incoordination
72
Stage 2 of Dementia Pugilistica
aphasia, apraxia, agnosia, apathy, flat affect, neuro s/s
73
Stage 3 of Dementia Pugilistica
global cognitive decline & parkinsonism
74
Second Impact Syndrome
Occurs when a second TBI occurs prior to initial TBI completing the healing process
Most likely to cause edema & diffuse damage
LOC doesn't have to be present
75
Long-term implications of Second Impact Syndrome
Increased muscle tone (spasticity), rapidly changing emotions (emotional lability), muscle spasms, hallucinations, difficulty thinking & learning
76
TBI in Infancy & Childhood
Projected mean of incidence of TBI in children younger than 15y is ~180 per 100K
Fracture of the skull is present in around 20-40% of cases
77
Abusive Head Trauma
Accounts for 25% of hospital admits in children less than 2yo
AKA shaken baby syndrome, non-accidental trauma, child maltreatment, child abuse
Subdural hemorrhage (SDH) is most common intracranial injury as a result
May lack communication skills to report headaches, sensory problems, communication, &/or similar symptoms
78
Symptoms manifested by Children with TBI
refusal to eat, appear listless & cranky, altered sleep pattern, changes in school performance, loss of interest in preferred activities
79
Abusive Head Trauma Statistics
SBS is the leading cause of child abuse deaths in USA (KY is #1);
Babies (newborn-4mos) are at greatest risk
Inconsolable crying is #1 trigger
1 in 4 shaken babies will die
Rare that a single instance of noted injury present in ED is 1st occurrence; usually a chronic history of abuse; (usually mom's boyfriend is perpetrator)
80
Possible Abusive Head Trauma s/s & results:
Glassy eyes, fixed pupil, fixed stare; seizures; lethargy & irritability; somnolence/ inactivity; respiratory problems; vomiting; choking; inability to lift head &/or turn to side; retinal hemorrhage; rigidity; decreased appetite; bluish color
81
Diffuse Axonal Injury
References the neuropathological changes that occur at the axonal level following trauma
Damage results from twisting, tearing, &/or shearing of axon
If tear enough, will see s/s
Has to occur in greater clumps to diagnose
82
Cerebral Edema
Brain swelling frequently follows trauma; appears to be more of a secondary injury than a primary injury; focal more common in adults whereas diffuse more common in pediatrics; results in increased cranial pressure (ICP)
83
Intracranial Pressure (ICP)
should be less than 20mmHg (millimeter Mercury); when exceeded, neurosurgical intervention is necessary
84
3 Mechanisms for Measuring ICP:
EVD, screw/bolt, epidural sensor
85
EVD
extraventricular drain (or intraventricular catheter); thin, flexible tube threaded into 1 of 2 lateral ventricles
86
Screw/Bolt (subarachnoid)
placed into the space between arachnoid membrane & cortex
87
Epidural Sensor
sensor placed in the epidural space below skull
88
Fontanelle
Allow for greater amount of cerebral edema; allow skull to separate & expand
89
Bulging Fontanelle
Increased CSF, brain swelling, etc. along with other symptoms
90
Craniocynestosis
as fontanelles grow together, sometimes they grow together weird
91
Monroe-Kellie Hypothesis
states the cranial compartment is incompressible; Skull, CSF, & brain tissue create a volume equilibrium such that any increase in volume of 1 of the cranial constituents must be compensated by a decrease in volume of another
92
Brain shift & herniation
if hematoma continues to enlarge or focal edema of adjacent brain tissue increases, brain may be shifted away from growing mass, & structures that normally lie in midline may be displaced; tumor is violation of Monroe-Kellie Hypothesis
93
Cushing's Triad
Significant sign of intracranial HTN
| Precursor to herniation
94
3 components of Cushing's Triad
hypertension (HTN) (red face, etc.); bradycardia (slow rate; check pulse); respiratory irregularity (fast-slow; long-short, etc.)
