TBI LECTURE

Question 1

length of stay for acute and IP Rehab

Answer 1

acute 18
IP rehab 21 days

Question 2

early med management for TBI

Answer 2

1. OPEN AIRWAY
   positioning
   provide O2
   endotracheal tube
   tracheostomy
   provide vent support
2. VITAL SIGNS, FLUID REPLACEMENT
3. NEURO CHECKS 15-30 MIN (no sleep!!!)

Question 3

Glasgow coma scale

Answer 3

-used at accident scene, ER, acute care
-used as predictor of outcome
-used in research
-high inter-rater reliability
-total score 3-15

Question 4

minimum score for GCS

Answer 4

3, highest 15!
may be separate into 3 sections (eye opening, best motor response, verbal response V-T MEANS CAN’T BE SCORED DUE TO TRACH)

Question 5

total score 3-8 for GCS

Answer 5

severe! (90% defined as coma)

44% of ED ADMIT

Question 6

limitations of GCS

Answer 6

-pre-existing cond (like language)
-aphasia
-alcohol/meds
-other injuries (like jaw crushed)

Question 7

what is mod injury for GCS

Answer 7

9-12

Question 8

what is mild injury for GCS

Answer 8

13-15
41% of people admitted

Question 9

local brain injury is defined as

Answer 9

TBI localized to site of impact on skull

Question 10

Diffuse brain injury

Answer 10

widely scattered shearing of axons (head bounced back and forth!)
HIGH VELOCITY LIKE CAR, SKII

Question 11

secondary insults can cause more injury than primary true or false

Answer 11

true

Question 12

ABOVE ___ MMHG ICP IS CONTRAINDICATION FOR PT

Answer 12

20 mmHg

Question 13

____ mmHg causes neurologic dysfunction

Answer 13

2-40 mmHg

Question 14

normal while lying down

Answer 14

0-10 mmHg

Question 15

__mmHg almost always results in death

Answer 15

60

Question 16

intracranial infections can happen due to

Answer 16

fx of skull
gunshot wound
open brain injury!!!!

Question 17

for cerebral arterial vasospasms, velocities over 100 means

Answer 17

NO OOB ACTIVITIES!
JUST SUPINE EXERCISES

Question 18

hydrocephalus

Answer 18

CSF on the brain
due to:
-foramina blocked by brain herniation
-or ventricles can push onto brain surrounding it

Question 19

secondary insults in TBI

Answer 19

-intracranial infection
-cerebral arterial vasospasm
-hydrocephalus
-post-traumatic epilepsy
-brain edema

Question 20

arterial hypoxemia

Answer 20

*breathing centers depressed
-present in 1/3 of pts in ER

Question 21

arterial hypotension

Answer 21

seldom produced by TBI
alone
-fx of bones, organs, etc

Question 22

anemia

Answer 22

blood loss from injury

Question 23

Hyponatremia

Answer 23

(serum sodium levels)

Question 24

hypoxia and ischemic brain damage

Answer 24

most commonly seen in hippocampus, BG, scattered sites of cerebral cortex, cerebellum

Question 25

what are two ways to evacuate a hematoma surgically?

Answer 25

craniotomy: less severe craniectomy: often leaves skull flap off, HELMET, go back for surgery months later

Question 26

what is a ventriculostomy

Answer 26

insertion of a device to measure ICP, requires burr hole usually of frontal bone thin catheter tube going through frontal bone...External ventricular drain OR bolt which measures only!

Question 27

everytime patient moves, what should happen with EVD?

Answer 27

must be re-leveled! MUST BE CLAMPED

Question 28

metabolic care of TBI

Answer 28

-in dwelling catheter -serum electrolytes -artificial feedings once bowel sounds return

Question 29

POPS

Answer 29

26 items in 5 categories -domestic life -major life activities -transportation -interpersonal interactions and relationships -community, recreational and civic life

Question 30

__% of individuals require some level of supervision at __ year post op __% require some supervision __ years post op

Answer 30

37% at 1 year 31% 2 years post op

Question 31

Rancho Los Amigos Levels of Cog Functioning Scale

Answer 31

1. NO RESPONSE (coma) 2. Generalized response (limited, inconsistent, non-purposeful, often to pain only) 3. localized response (purposeful responses, MAY follow simple commands, may focus on presented objects ***PULL AWAY TO PAIN

Question 32

WHAT COMA SCALE distinguishes Rancho II vs III?

Answer 32

JFK! more sensitive than GCS and Rancho -MINIMALLY CONSCIOUS STATE RANCHO III -frequent misdiagnosis without JFK, HUGE implications for DC placement from acute care

Question 33

post-traumatic amnesia (PTA)

Answer 33

period of time from accident to time patient starts to have on going short term memory

Question 34

What test is used to determine when patient progresses out of PTA?

Answer 34

GOAT galveston orientation and amnesia test must have 3 consec scores of over 75 to be out of PTA

Question 35

Rancho Level 4

Answer 35

confused, agitated Heightened state of activity; confusion, disorientation; aggressive behavior; unable to do self-care; unaware of present events; agitation appears related to internal confusion.

Question 36

what are causes of agitation?

Answer 36

-fronto-orbital anterior temporal loves sylvian fissure -temporal lobe seizures -diffuse axonal injuries, esp corpus callosum, dorsolateral columns of midbrain -secondary effects of hypoxia, compression, neurohormonal effects premorbid personality

Question 37

causes of agitation

Answer 37

environment: sensory overload or deprivation reversible factors: seizures, sleep disturbances, electrolytes, meds, nutrition

Question 38

agitated behavior scale

Answer 38

observational tool Observational tool to assess the extent of agitation during acute phase of recovery from TBI  14 item instrument  Minimum score of 14, maximum of 56 Each item rated 1 (not present) to 4 (present to extreme degree)

Question 39

MOSS attention rating scale

Answer 39

Observational tool to measure attention-related behaviors after TBI 22 items Scores range 22-110 Includes phrases with both good and impaired attention Higher score = better attention Appropriate for moderate to severe brain injury

Question 40

RANCHO LEVEL 5

Answer 40

confused, inappropriate, non-agitated Appears alert; responds to commands; distractible; does not concentrate on task; verbally inappropriate, does not learn new information.

Question 41

RANCHO LEVEL 6

Answer 41

confused, appropriate (still in PTA) Good directed behavior, needs cueing; can relearn old skills (ADL); serious memory problems; some awareness of self and others.

Question 42

RANCHO LEVEL 7

Answer 42

automatic, appropriate Robot-like appropriate behavior with minimal confusion; shallow recall; poor insight into condition; initiates tasks but needs structure; poor judgment, problem-solving and planning skills

Question 43

RANCHO LEVEL 8

Answer 43

8. Purposeful, appropriate. Alert, oriented; recalls and integrates past events; learns new activities and can continue without supervision; cognitively independent in living skills; capable of driving; defects in stress tolerance, judgment, abstract reasoning persist; many function at reduced levels in society.