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TBI Flashcards

1
Q

how often are neuro check performed during early medical management of a TBI?

A

every 15-30 mins

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2
Q

what are the 3 components of the Glasgow Coma Scale?

A

eye opening
best motor response
verbal response

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3
Q

what is the lowest Glasgow Coma Scale score? highest?

A

lowest - 3
highest - 15

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4
Q

a Glasgow Coma Scale score of ____ indicates severe injury

A

3-8

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5
Q

Glasgow Coma Scale score of ___ indicates moderate injury

A

9-12

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6
Q

Glasgow Coma Scale score of ___ indicates mild injury

A

13-15

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7
Q

what does a Glasgow Coma Scale score of “T” mean?

A

cannot be scored

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8
Q

what are the limitations of the Glasgow Coma Scale?

A

pre-existing conditions (language)
aphasia
alcohol or other meds
other injuries

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9
Q

what is a local brain injury?

A

localized to the site of the impact on the skull

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10
Q

what is a diffuse brain injury?

A

widely scattered shearing of axons
(DAI)

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11
Q

what causes DAI?

A

high velocity impact

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12
Q

what are the primary brain insults?

A

local brain injury
diffuse brain injury (DAI)

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13
Q

what are the secondary brain insults?

A

raised ICP
intracranial infection
cerebral arterial vasospasm
hydrocephalus
post-traumatic epilepsy
brain edema
arterial hypoxemia
arterial hypotension
anemia
hyponatremia
intracranial hematoma

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14
Q

what is normal ICP?

A

0-10 mmHg WHILE SUPINE

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15
Q

what is abnormal ICP?

A

20 mmHg

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16
Q

what ICP is a contraindication to PT?

A

above 20 mmHg

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17
Q

what ICP causes neurologic dysfunction?

A

20-40 mmHg

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18
Q

what ICP causes death (almost always)?

A

60 mmHg

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19
Q

if a patient has a transcranial doppler result of a velcity over 100, what can be done in PT?

A

no OOB activities
supine exercises OK

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20
Q

ventricle will appear ____ with hydrocephalus

A

bigger

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21
Q

brain edema will causes the ventricles to appear ____

A

smaller

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22
Q

what condition is present in 1/3 of TBIs presenting to the ER and can be due to depressed breathing centers or drowning?

A

arterial hypoxemia

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23
Q

what condition is seldom produced in a TBI but can occur with GSW, long bone fx, and liver laceration?

A

arterial hypotension

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24
Q

what structures are hypoxic and ischemic brain damage most commonly seen in?

A

hippocampus
basal ganglia
scattered sites of cerebral cortex
cerebellum
(parts that requires the most O2)

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25
which is more localized? hypoxia or ischemia?
ischemia
26
what color is normal CSF?
clear
27
what is the purpose of a ventriculostomy?
measures and drains CSF via external ventricular drain (EVD)
28
what is the purpose of a bolt?
measures ICP only
29
the pressure transducer of an EVD should be level with ___
external auditory meatus
30
what must occur to the EVD prior to mobilization?
must be clamped if can't clamp, must have nurse to move it constantly
31
what meds can be given to TBI patients?
anti-convulsant corticosteroids sedatives/anesthetics skeletal muscle relaxants skeletal muscle paralytics CV meds antibiotics narcotic analgesics
32
what are some treatments for a raised ICP?
osmotic therapy (diuretic) sedative/hypnotic vasoreductive therapy (hyperventilation) skeletal muscle paralytics &/or relaxants core temperature/therapeutic hypothermia
33
what is a sign of irritation with brain herniation?
fever
34
what can be caused by damage to the hypothalamus?
fever ("neurogenic fever")
35
what causes intracranial hypertension?
loss of autoregulation of cerebral blood flow increases blood-brain volume
36
systemic arterial hypertension can be caused by
noxious stimuli
37
systemic arterial hypertension can result in
blood-brain barrier disruption and causes more brain edema
38
what is the most common cardiac symptom of TBI?
tachycardia
39
what regions control heart rate?
diencephalon (caudally to myelencephalon (medulla))
40
when is recovery most rapid after a TBI?
1 year post
41
when is recovery most rapid after a stroke?
3-6 months
42
which scale is used to track individuals from coma to community?
disability rating scale (DRS) scored from 0-30 addresses impairment, disability, & handicap
43
which outcome measure assesses the ability to fulfill life roles & ecologically support self?
Craig Handicap Assessment & Reporting Technique (CHART)
44
what are the categories for Craig Handicap Assessment & Reporting Technique (CHART)?
physical independence mobility occupation social integration economic self-sufficiency cognitive independence
45
what outcome measure looks at the importance of the ability to do certain activities?
participation objective/participation subjective (POPS)
46
what are the categories for the participation objective/participation subjective (POPS) scale?
domestic life major life activities transportation interpersonal interaction and relationships community, recreational, and civic life
47
what are major predictors of TBI outcome?
degree and duration of LOC post-traumatic amnesia
48
which outcome scale can be added to the FIM for TBI & CVA?
FAM
49
which outcome scale is designed to assess high-level motor performance in patients with TBI
hi-level mobility assessment tool (HiMAT)
50
what are the minimum mobility requirements for the HiMAT?
independent walking 20 meters without gait aids
51
what is a Rancho level 1?
no response unresponsive to stimuli definition of a coma
52
what is a Rancho level 2?
generalized response non-purposeful response to pain only
53
what is a Rancho level 3?
localized response purposeful response simple commands, focus on object
54
what is a Rancho level 4?
confused, agitated
55
what is a Rancho level 5?
confused, inappropriate, non-agitated in PTA stage
56
what is a Rancho level 6?
confused, appropriate can relearn old skills (ADLs) in PTA stage
57
what is a Rancho level 7?
automatic, appropriate minimal confusion
58
what is a Rancho level 8?
purposeful, appropriate alert, oriented cognitively independent in living skills capable of driving
59
which Rancho level is the first stage out of PTA?
7
60
which Rancho level is the first stage capable of driving?
8
61
difference between coma and PVS?
coma - appears asleep, doesn't move lasts 2 weeks max Rancho 1 PVS - sleep/wake cycles can last indefinitely Rancho 2-3
62
which Rancho level is a minimally conscious state?
3
63
which outcome can differentiate Rancho levels and detect minimally conscious state?
JKF coma/near coma scale
64
which outcome scale is a huge implication for d/c placement from acute care for coma patients?
JKF coma/near coma scale
65
what is post-traumatic amnesia (PTA)?
period of time from the accident to the time that the patient starts to have on-going short-term memory
66
how long does PTA generally last?
3-4 times the length of unconsciousness
67
which outcome scale is used to determine when a patient is progressing out of PTA?
Galveston Orientation & Amnesia Test (GOAT)
68
what GOAT score must a pt have to be considered out of PTA?
3 consecutive scores of >75
69
which regions can lead to agitation if injured?
fronto-orbital anterior temporal lobes Sylvian fissure temporal lobes seizures DAI of corpus callosum & dorsolateral columns of midbrain
70
secondary effects of ____, ____, and ____ can cause agitation
hypoxia compression neurohormonal effects
71
what type of activities should be done in PT with an agitated pt?
automatic activities
72
what is an observational tool to assess the extent of agitation during acute phase of recovery from TBI?
agitated behavior scale
73
what is an observational tool to measure attention-related behaviors after TBI?
Moss attention rating scale (not for coma or PVS)
74
definition of mild TBI (factors)
traumatically induced disruption of brain function as manifest by at least one: - any period of LOC - loss of memory for immediate pre and post events - change in mental state at time of accident - focal neuro deficits (transient or lasting)
75
severity of mild TBI does not exceed: LOC: GCS after 30 mins: PTA:
LOC: ~30 mins GCS: 13-15 PTA: 24 hrs
76
what is the most commonly reported symptom of mild TBI?
HA

Neuro MSK (15 decks)

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