TBI

Question 1

Add pleural effusion

Question 2

Normal ICP for a supine Pt.

Answer 2

10-15 mmHg

Question 3

What is the ceiling ICP in many ICUs

Answer 3

20mmHg

Question 4

What happens if the ICP equals MAP

Answer 4

Perfusion ceases and brain dies

Question 5

What is cerebral perfusion pressure

Answer 5

Indicates adequate perfusion to brain, which can be measured directly

Question 6

Formula for cerebral perfusion pressure (CPP)

Answer 6

MAP-ICP

Question 7

What is a normal CPP value

Answer 7

65-80

Question 8

What GCS indicates mild TBI

Answer 8

14-15

Question 9

What GCS indicates moderate TBI

Answer 9

9-13

Question 10

What GCS indicates severe TBI

Answer 10

Equal or less than 8

Question 11

Why do patients with TBI get blown

Answer 11

Optic nerve is paralyzed

Question 12

What is mydriasis

Answer 12

A blown pupil

Question 13

What is decorticate posture

Answer 13

Abnormal flexion

Question 14

What is decerebrate

Answer 14

Abnormal Extension

Question 15

What are symptoms of impending or active cerebral herniation

Answer 15

Decorticate or decerebrate

Pupillary asymmetry

Bilateral or unilateral fixed and dilated pupils

Cushing triad: hypertensio, Brady and irregular RR

Question 16

What causes brain herniation

Answer 16

Increased cerebral pressure

Question 17

What is the danger of brain herniation

Answer 17

ICP squeezes brain out of its restraints (skull)

Question 18

What is a midline shift (brain)

Answer 18

BBB is compressed (mass effect)

Compresses the ventricle and pushes midline over

Question 19

Examples of primary brain injury

Answer 19

Direct impact

Rapid acceleration and deceleration

Penetrating injury

Blast wave

Question 20

What are examples of secondary brain injury

Answer 20

Cerebral edema

Inflammation

Electrolytes imbalance

Death of neurons

Question 21

What causes secondary brain injury

Answer 21

Subtle changes in the brain and nervous system that follow primary injury

Question 22

Time course of cerebral edema

Answer 22

Accumulation is gradual

Peaks in a few days

Contributes to intracranial hypertension

Question 23

What is the most common cause of cerebral edema

Answer 23

Vasogenic edema

Question 24

What is the goal for treatment of TBI

Answer 24

Treat primary brain injury

Stall or minimize secondary brain injury

Question 25

What is the danger of cerebral edema

Answer 25

At the time of initial injury, a catecholamine surge increases HR and BP potentially damaging brain’s architecture

Question 26

What are the four interventions for treating ICP

Answer 26

Hyperosmolar 4 solution External ventricular drains Evacuation of blood clot Craniectomy

Question 27

What are hyperosmolar solutions

Answer 27

Mannitol (IV) Hypertonic saline 3% (IV)

Question 28

How does hyperosmolar IV work

Answer 28

Pulls fluid back into vessels

Question 29

Danger of intubating a patient with ICP

Answer 29

Intubation can increase it Gentle intubation technique Comatose patients can still generate reflex response (stim of supraglottic larynx)

Question 30

What are respiratory therapist role in avoiding secondary injury of ICP

Answer 30

Prevent 2nd injury Gentle intubation Mgt vent Mgt O2

Question 31

Hazards when hyperventilating patients with ICP

Answer 31

PaCO2 <25mmHg can decrease ICP, but can reduce blood delivery

Question 32

Should hyperventilation be used for ICP

Answer 32

Can be, but should be avoided 25-30mmHg

Question 33

When is hyperventilation with ICP dangerous

Answer 33

24-48 hrs Tolerance increases after

Question 34

Means to relieve ICP

Answer 34

Extraventricular drains Evacuation of blood clot Crainectomy

Question 35

How doe craniectomy work

Answer 35

Open skull Remove clot Give brain room to expand Return

Question 36

Difference between crainectomy vs Crainotomy

Answer 36

Otomy is returned Ectomy is held

Question 37

What does IICP stand for

Answer 37

Increased intracranial pressure