LOC and Coma

Question 1

Classification of TBI based on Glasgow scale

Answer 1

Mild: GCS—13-15 measured 30 min after injury
Moderate: GCS—9-12
Severe: GCS < 8

Question 2

Brain injury associated w/ grossly normal neuroimaging studies

Answer 2

concussion

Question 3

Age groups of patients at highest risk for concussion

Answer 3

< 5YO and > 60YO

Question 4

Leading cause of death for ppl age 1-45 in North America

Answer 4

TBI

Question 5

Sx that indicate more serious brain injury or rising ICP

Answer 5

Seizures, Focal neurologic signs, Worsening HA, confusion, lethargy, Protracted N/V

Question 6

Signs of basilar skull fracture

Answer 6

raccoon eyes, Battle sign, hemotympanum

Question 7

Criteria for hospital admission of TBI

Answer 7

GCS < 15 or deteriorating, Abnormal CT, Seizures, Abnormal bleeding parameters

Question 8

How often should an observer awaken an outpatient TBI patient?

Answer 8

every 2 hours

Question 9

Sequelae from repeated TBI

Answer 9

Boxers: dementia pugilistica (20%). Football players: chronic traumatic encephalopathy

Question 10

Condition where patient is unarousable and unresponsive. Lasts > 1 hour

Answer 10

Coma

Question 11

Type of posturing: UE adduction, (flexion at the elbows and fingers) with LE extension (plantar flexion and inversion

Answer 11

Decorticate posturing: Dysfunction of cerebral cortex or thalamic damage

Question 12

Type of posturing: UE extension, adduction and pronation with LE extension

Answer 12

Decerebrate posturing: Injury to caudal diencephalon, midbrain or pons

Question 13

What should you give someone with a TBI?

Answer 13

Give O2, thiamin, fluids, narcan, glucose

Question 14

Respiratory pattern that is cyclic; hypernea & apnea—seen patients w/ bilateral hemispheric or diencephalic insults

Answer 14

cheyne-stokes

Question 15

type of respiration seen with injury to pontine or midbrain tegmentum

Answer 15

hyperventilation

Question 16

Type of breathing with prolonged pause end of inspiration—indicates lesions to mid- and caudal pons

Answer 16

Apneustic breathing

Question 17

Type of breathing that is irregular in rate and tidal volume—damage to medulla

Answer 17

Ataxic breathing

Question 18

What can happen if you give glucose before thiamine?

Answer 18

precipitate an encephalopathy

Question 19

Why should you do neuroimagina and coagulation tests before doing an LP?

Answer 19

to make sure there isn’t increased ICP. if you take out CSF you will decrease ICP and the brain will fall out through the hole in the bottom of the skull

Question 20

Where does the Ascending reticular activating system (ARAS) originate?

Answer 20

upper pons and midbrain

Question 21

Pathophysiology of TBI that results in coma

Answer 21

Focal lesions to the upper brainstem can alter alertness by damaging the ARAS

Question 22

Which type of posturing has a better prognosis?

Answer 22

decorticate