TBI: Medical and Neurologic complications after TBI Flashcards
(33 cards)
What is heterotopic ossification (HO)?
Formation of mature lamellar bone in extra skeletal soft tissue
Heterotopic ossification can occur in various conditions and is characterized by abnormal bone growth outside of the skeleton.
What are the risk factors (6) for developing heterotopic ossification?
- Coma >2 Weeks
- Immobility
- Spasticity
- Long bone fracture
- Ulcers
- Edema
HO typically develops 3-4 months post-injury.
2 most common signs of HO?
Pain and decreased range of motion (ROM)
What is the primary location for heterotopic ossification after TBI?
HIPS
What laboratory findings may be elevated early in cases of heterotopic ossification?
Serum alkaline phosphatase
Elevated levels can indicate bone turnover and should be monitored in patients at risk for HO.
When can heterotopic ossification be detected by bone scan?
Weeks 2-4 in phase 1 and phase 2, and weeks 4-8 in phase 3
Bone scans are useful for early detection of HO before it becomes visible on X-rays.
How long does it take for X-rays to reveal heterotopic ossification after an injury?
3 weeks to 2 months post-injury
X-rays will show maturity of HO after this period.
What are 3 prophylactic measures to prevent heterotopic ossification?
- Range of motion (ROM) exercises
- Control of spasticity
- NSAIDs
What treatment options are available for heterotopic ossification?
- Bisphosphonates
- NSAIDs (e.g., indomethacin)
- ROM exercises to prevent ankylosis
- Surgical resection to restore function (usually wait 12-18 months)
Treatment aims to manage symptoms and restore mobility while allowing HO to mature.
True or False: Radiation can be used to inhibit heterotopic ossification in traumatic brain injury (TBI) patients.
False
Radiation is effective in total hip replacement patients but is contraindicated in TBI patients.
What medicaiton is used for post TBI HTN?
propranolol
due to sympathetic overdrive, transitory and will resovle
–– Plasma catecholamine levels
–– Cardiac index
–– Myocardial oxygen demand
–– Heart rate
–– Improves pulmonary ventilation-perfusion inequality
What is the the gold standard for diagnosis of clinically suspected DVT
contrast venography
which ranchos los amgios level is associated with poor ability to wearn patient off alt feeding?
5
How does spasticity in acute TBI affect total body energy use?
Increased muscle tone causes hypermetabolism, raising energy use from 100% to 140%.
What is the recommended duration for G and J tubes to decrease complications?
At least 30 days.
What should be done if a patient with enteral feeding has GERD and recurrent aspiration?
Consider distal tube placement.
How can esophagitis be reduced in patients with enteral feeding?
Head elevation and antacids can help reduce esophagitis.
What is the most common cause of feeding intolerance in enteral feeding? how to treat?
High gastric residue. Tx with NG delivered erythromycin
What GI medication should not be used in TBI due to sedation and extrapyramidal side effects?
Metoclopramide.
What are the risks associated with parental feeding?
Line complications (infection, clots, edema), electrolyte, and metabolic abnormalities.
What is thge most common hormone in hypothalamic pituitary dysfunction associated with TBI and its prevalence in TBI?
Growth factor
50%
What is the evaluation timeline for endocrine function tests after TBI?
3 months and 1 year.
What causes SIADH?
inc ADH secretion > water retention -> NA excretion in urine maintained by hypervolemia, suppression of RAAS and inc plasma concentration of ANP(atrial natriuretic peptide)
What symptoms are associated with mild hyponatremia?
Anorexia and nausea/vomiting.
