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Neuromuscular management > Lecture 5 - TBI > Flashcards

Lecture 5 - TBI Flashcards

1
Q

What is more expensive, acute care, or inpatient rehab?

A

Acute care

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2
Q

Early medical management of a TBI

A

Establish open airway

check vital signs

fluid replacement

Neuro checks every 15-30 mins

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3
Q

Glasgow Coma Scale:

What does the score range between?

How is it used?

A

3-15 (worst is 3)

Used at scene of accident, in ER, throughout acute care

used as a predictor of outcome

used in research

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4
Q

What are the 3 components of the glasgow coma scale?

A

Eye, Verbal, Motor Response

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5
Q

Glasgow coma score meanings:

3-8

9-12

13-15

A

3-8 Severe injury (defines coma in 90% of cases)

9-12 moderate injury

13-15 mild injury

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6
Q

What are limitations of the glasgow coma scale

A

Pre-existing conditions

aphasia

alcohol or medications

other injuries (example : jaw injury makes it hard to talk)

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7
Q

Local brain injury vs Diffuse axonal Injury

A

Local brain injury : localized to the site of impact on skull

Diffuse axonal injury: widely scattered shearing of axons

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8
Q

Intracranial pressure norms:

0-10

10-20

20-40

60

A

0-10 normal while laying down

10-20 Abnormal

20-40 Contraindication for PT, causes neurological dysfunction

60+ almost always results in death

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9
Q

What can cause an intracranial infection?

A

Foreign objects in brain from the injury

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10
Q

How can a hemmorhage cause cerebral arterial vasospasm

A

blood where its not suppose to be irritates the smooth muscle of the vessels and causes vasospasm

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11
Q

Hydrocephalus vs brain edema?

A

Hydrocephalus : CSF build up where it’s not suppose to be

Brain edema- the brain cells are swollen

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12
Q

What could cause arterial hypoxemia from a TBI

A

Depressed breathing centers

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13
Q

What could cause arterial hypotension from a TBI

A

Bleeding elsewhere in the body

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14
Q

How is anemia caused from a TBI?

Hyponatremia?

A

anemia- bleeding

hyponatermia - sodium loss

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15
Q

Distortion vs midline shift

A

Distortion is a smaller shift than a midline shift, doesn’t move the whole brain over

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16
Q

What is the difference between hypoxemia and ischemia?

A

hypoxemia- less oxygen in blood

Ischemia- bloodflow isnt happened

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17
Q

Where is hypoxemic and ischemic brain damage commonly seen?

A

Hippocampus, basal ganglia, scattered sites of cerebral cortex and cerebellum

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18
Q

What is the difference of a craniotomy vs a craniectomy

A

Craniotomy - Make a hole to let pressure drain

Craniectomy - remove flap that they’ll put back later

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19
Q

What is a ventriculostomy?

A

Used to insert a measurement/drain device into the ventricles to measure intracranial pressure

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20
Q

How does an EVD (external ventricular drain) work?

A

Measures intracranial pressure

Must be kept level with patients head at all times to work

check with nurse before mobilization

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21
Q

an average adult with a TBI in the ICU requires how many calories per day?

A

3000 kcal atleast

note: articifial feeding once bowel souns return via nasogastric tube, gastrotomy, jujunostomy

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22
Q

Damage to the hypothalamus can cause ________ fever

A

Neurogenic fever

note: a fever can be signof iritation with a brain herniation and causes increased caloric/metabolic demand of brain

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23
Q

Systemic arterial hypertension can result in blood brain barrier disruption causing more __________

loss of autoregulation of cerebral bloodflow increases blood-brain volume AKA ____________

A

brain edema

inracranial hypertension

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24
Q

What is the most common side effect related to heart rate stemming from a TBI?

A

Tachycardia

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25
Participation vs Activity vs Body Structure/function scales What is the definition of each?
**Participation** - how well they're doing *socially* ability to *participate in life* **Activity**- Measures their overall physical functional abilities (example: *how they walk/run*) **Body structure/function**: Measures more specific things related to their body. example: *spasticity*
26
How is the disability rating scale scored? What does it measure?
0-no disability to 30 - death It measures PARTICIPATION
27
What does the CHART (Craig Handicap assessment/reporting technique) measure?
Physical independence Mobility Occupation Social Intregration Economic Self Sufficiency Cognitive Independence Note: it's also a **participation** measure
28
What does the POPS measure (Participation Objective/ Participation subjective)
Measures **participation**... 26 items in 5 categories Example: in a typical month how often do you go to the movies? How important is this to your well being? are you satisified or would you like to be doing more or less?
29
What are the 4 supervision categories on the supervision rating scale?
Overnight supervision Part time supervision Full time indirect supervision full time direct supervision
30
When does most improvement on the supervision rating scale happen?
First year note: overall most recovery for everything happens in first year
31
What is the UDS-FIM
an ACTIVITY measure
32
What is HIMAT? HiLevel Mobility Assessment tool
**Activity** measure note: minimum mobility requirement: independent walking 20 meters Includes walking, running, jumping, stairs…
33
What is Rancho level 1?
No response
34
What is Rancho level 2?
Generalized Response non-purposeful responses, often to pain only
35
What is Rancho level 3?
Localized response purposeful responses, can follow simple commands or focus on object.
36
What is rancho level 4?
Confused Agitated
37
What is rancho level 5?
Confused, inappropriate, non-agitated appears alert, verbally inappropriate, unable to learn new information
38
What is rancho level 6
Confused, Appropriate good directed behavior, can relearn old skills, serious memory problems, has self awareness
39
What is Rancho level 7?
Automatic Appropriate Robot-like appropriate behavior with minimal confusion poor insight into condition, poor judgement and problem solving
40
What is rancho level 8?
Purposeful Appropriate Alert/oriented can recall and integrate past events cogntitively independent many function at reduced levels in society at this level
41
How is mild traumatic brain injury defined?
By atleast one of these: Any period of loss of conciousness any loss of memory any change in meental state at time of accident focal neuro deficits
42
What is the JFK Coma/near coma scale?
scale used to monitor alertness for patients in a coma/PVS more sensitive than glassgow and rancho shows emergence from coma/PVS to a minimally concious state
43
What is the average duration of unconciousness after a traumatic brain injury
7.87 days Most have under 1 day though. (46%) 25% have between 2-7 days of unconciousness
44
How will TBI patients typically present?
Lots of **tubes** asleep or awake high risk for skin breakdown **unstable** vital signs increased risk of **seizures** **NPO** (nothing by mouth) Extreme levels of **hypertonicity**
45
How will a patient in a coma appear?
no eye opening (even spontaneously), nor movements or vocalization
45
How long does a coma usually last?
Not more than 2 weeks
46
How will a patient in a persistent vegetative state appear?
Can have eyes open, move spontaneously, but unable to follow commands or speak, they will have sleep/wake cycles
47
How long can a persistent vegetative state last for
indefinitely
48
How is the JFK coma scale scored?
0 is worst, 23 is best
49
What are the categories of the JFK coma scale?
auditory, visual, motor, oromotor/verbal, communication, and arousal.
50
What is post traumatic amnesia PTA
Period of time from the accident to the time a patient starts having ongoing short term memory patients will often not remember the accident or the events immediately preceding it
51
How long does PTA usually last?
Generally lasts 3-4 times the length of unconciousness so if you were unconcious for 24 hours you wouldnt remember 3-4 days
52
What is the average duration of PTA (post traumatic amnesia)
23 days
53
What is the galveston orientation and amnesia scale? How is it scored?
Used to determine when a patient is **progressing out of PTA** Must have 3 consecutive scores of *75+* to be out of PTA
54
Causes of agitation
Actual **site of injury**: Slyvian Fissure Temporal Lobe Diffuse axonal injury Esp of corpus callosum and dorsolateral columns of midbrain secondary effects of **hypoxia** and **compression**, neuro hormones Or **pre-morbid personality** **Environment** (sensory overload or deprevation)
55
What are reversable factors of agitation?
Seizures Sleep disturbances Electrolytes Medication Nutrition
56
How can physical therapy help patients with agitation
get them up and walking and change enviroments
57
What scale measures agitation from a TBI?
Agitated behavior scale minimum score of 14, max of 56 higher score = more agitation
58
What scale measures attention after a TBI
Moss Attention Scale Scores 22-110 Higher score = better attention not appropriate for patients in PVS or coma
59
What is the classification for a mild traumatic brain injury?
Traumatic induced disruption of brain manifested by atleast one of these: Any period of LOC Any memory loss any change in mental state at time of accident Focal neuro deficits (transient or lasting)
60
In order to have a MILD traumatic brain injury, the severity should not exceed:
LOC greater than 30 mins After 30 mins they must score no less than 13-15 on the Glassgow coma scale
61
Symptoms of mild TBI are not commonly reported initially but ______________ what is the most common reported symptom?
Surface later and last 1 year or more headaches
62
What are symptoms of a mild TBI
Physical: Headache, dizziness, balance, sleep disturbances, fatigue, tinnitis, diplopia, Cognitive: attention, concentration, perception, memory, executive functions Behavioral: irritability, disinhibition, emotional lability
63
How long is the period of rapid recovery after a TBI? What happens after?
Most recovery happens in 1 year at inpatient rehab activity and participation levels tend to plateau between 1-2 years post injury
64
What should you say and not say when working with TBI patients and families
dont: "I know just how you feel" DO: show empathy, be mindful w/ words educate and reinterate provide resources remind them of loved ones progress

Neuromuscular management (19 decks)

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