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Semester 5 PMNM Exam 7 > TBI - Medical Management > Flashcards

TBI - Medical Management Flashcards

(73 cards)

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1
Q

Definition

A

Blow or jolt to the head or a penetrating head injury

Disrupts function of the brain

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2
Q

What is the leading cause of TBI

A

Falls (47% resulting in ED visit, hospitalization, or death

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3
Q

What age group is most common for TBI

A

Children 0-14 (54%)

Adulta over 65 (79%)

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4
Q

TBI - M vs. F

A

M 3 x more likely to die from TBI than women

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5
Q

Mechanisms of brain injury

A 
Acc-Dec 
Direct blow to head
Blow to other body part
Blast waves
Shaking
Head rotation
Penetrating injury
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6
Q

Assessment TBI

A

GCS
Pupillary response
S/S with early vs. late signs

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7
Q

Glascow Coma Scale is used to measure what

A

Gold standard to assess LOC

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8
Q

What is the most useful clinical sign of deterioration

A

Change in LOC

Using the GCS

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9
Q

GCS - unable to use if

A

Hypoglycemic
Hypothermia
Shock
Alcohol/Drug

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10
Q

Pupillary Response - only important when

A

there are changes or deterioration in LOC

Not necessary with a GCS of 15

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11
Q

Pupillary response - if adverse response means what

A

Oculomotor nerve 3 - something is compressing the nerve and causing an adverse response to light

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12
Q

GCS scores range from

A

15 to 3

Lowest 3

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13
Q

GCS what is considered a coma

A

Less than 8

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14
Q

GCS - T or F - A person identified as brain dead can still have a GCS score of 3

A

TRUE

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15
Q

GCS - start with what

A 
least invasive to the most invasive 
(4) observe if they have their eyes open spontaneously 
If not, then try speech (3)
pain (2)
no EO (1)
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16
Q

GCS - verbal response

A 
5 oriented
4 confused
3 inappropriate words
2 incomprehensible words
1 no verbal response (on vent can be 1)
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17
Q

GCS - Motor Response

A

6 obeys commands
5 localizes pain
4 withdrawal to pain
3 abnormal flexion - decorticate posturing
2 abnormal extension - decelerate posturing
1 no motor response

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18
Q

What is typically the most important component of the GCS

A

Motor response

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19
Q

Pupil Response can be

A

Brisk
Sluggish
No rxn

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20
Q

Pupil Response - size

Pupil dilation is ___ to injury

A

Varies

Pupil dilation is ipsilateral to injury

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21
Q

Early s/s neuro deterioration

A 
HA
Drowsiness
Disorientation
Agitation
N/V
Irritability
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22
Q

Late s/s neuro deterioration

A 
Posturing
Seizing
Pupil dilation
Asymmetrical pupil response
Cushings triad
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23
Q

Late s/s neuro deterioration - cushing’s triad

A

Bradycardia
Irregular respirations
HTN, wide pulse pressure

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24
Q

Classification of brain injury is based on what

A

GCS score

Duration of amnesia

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25
Classification of brain injury - Mild - what GCS score and how long amnesia
More then or equal to 13 | Less than 24 hours
26
Classification of brain injury - Mild - Clinical presentation
Awake, EO, Confusion, Memory and attn deficits, HA, Bx problems
27
Classification of brain injury - Moderate - what GCS score and how long amnesia
9-12 GCS | 1-7 days amnesia
28
Classification of brain injury - Moderate - clinical presentation
Lethargic, EO to stimulation, Sleepy, Arousable
29
Classification of brain injury - Severe - GCS score and how long amnesia
Less than or equal to 8 | 1-4 wks (can last 1-2 months too though)
30
Classification of brain injury - Severe - Clinical Presentation
Coma, EC even with stimulation
31
Classification of brain injury - which ones are hospitalized
Moderate to Severe
32
Diagnostic Evaluation includes what
CT scan MRI EEG
33
Patterns of brain injury - Primary injury
Immediate result of direct cellular damage from a traumatic event Unable to reverse the injury Types - focal and diffuse
34
Patterns of brain injury - Secondary injury
Occurs hrs to days after initial injury Disruption of blood flow and oxygen to brain Focus tx on preventing this second injury It is the damage occuring as a result of the body's response to the first injury
35
Categories of Primary Injury - Diffuse (global)
Concussion - blow to head Directly impacts consciousness Diffuse axonal injury
36
Categories of Primary Injury - Focal (local)
Skull fractures Intracranial hemorrhages Contusion Indirectly affect consciousness
37
Skull fractures - Types - Linear Basilar
``` Raccoon eyes (ant fossa) Battle signs (middle) CSF otorrhea (middle) ```
38
Skull Fractures - Types - Depressed Skull Fracture
Will have injury underneath - contusion
39
Intracranial hematomas - Epidural
``` Arterial in origin Rapid onset Hx of immediate LOC, awake, and then LOC Immediate surgery needed Better outcome if caught early ```
40
Intracranial hematomas - Subdural
Venous in origin Acute or chronic onset Worst outcome Supportive or Surgical evacuation
41
Intracranial hematomas - Intraparenchymal
Bleeding in brain tissue, small large, single or multipl Edema is pronounced Supportive management
42
Monitoring
CR Arterial line Central venous pressure ICP and cerebral profusion pressure
43
Indication for ICP monitoring
GCS score less than 8 AND an abnormal CT scan Two of the following: Symptomatic with bilateral motor posturing Syst BP less than 90 Age over 40
44
Pathophysiology - Intracranial vault consists of what components
Brain tissue (80%) Blood (10%) CSF (10%)
45
Pathophysiology - Monroe Kellie Hypothesis
If volume in any component changes, the other areas have to compensate If unable to compensate, the ICP will inc
46
ICP measures what
Pressure exerted by brain tissue, blood, and CSF within the cranial vault
47
ICP measures - normal
0 to 10 mmHg
48
ICP measures - abnormal
Greater than 20 for more than 5 minutes | You will initiate tx if greater than 20
49
Cerebral perfusion pressure - is what
Pressure at which the brain is perfused | Regulates cerebral blood flow - indirect measure of cerebral blood flow
50
Cerebral perfusion pressure - how to calculate
CPP = MAP minus ICP
51
CPP - normal range
Adult over 70
52
CPP - what level will lead to hypoperfursion of the brain and lead to ischemia
Less than 40
53
Cerebral blood flow - is regulated why
to supply brain with oxygen and glucose | If not maintained, ischemia occurs to the brain
54
Factors for regulating CBF
``` CPP ICP BP (MAP) Autoregulation to changes in BP Chemoregulation responst of BVs to hypoxia, CO2 ```
55
CBF - if you have high carbon dioxide what happens
Vasodilate - inc CBF - inc ICP
56
CBF - if low carbon dioxide what happens
Vasoconstrict - dec CBF
57
Tx goal of TBI
Focus on factors that cause further injury | Intervention to reduce risk of secondary injury
58
Early management
``` Airway/Cervical Spine precautions Breathing Circulation Disability (GCS) Exposure ```
59
TBI management - Airway/Breathing
Intubate if GCS less than 8 We want SaO2 95% or higher Maintain PaCO2 35-40
60
TBI management - Circulation
Control bleeding Maintain adequate BP (IV fluids, Blood administration, Vasopressor) Normovolemia - maintain CVP between 5 and 10
61
TBI management - optimize positioning to improve venous return
Head of bed raised 30 degrees Neutral head position Ensure C collar is not too tight Avoid extreme hip flexion
62
TBI management - decrease metabolic rate
``` Reduce environmental stimulation Sedation meds Analgesia meds for pain NM blockade (paralytics) Normothermia ```
63
TBI management - Lowering ICP
External ventricular drain | Hyperosmolar therapy
64
TBI management - Lowering ICP - External ventricular drain
Drains CSF to reduce intracranial volume | Measures ICP at same time too
65
TBI management - Lowering ICP - Hyperosmolar Therapy
Dec cerebral edema Meds - mannitol, hypertonic saline These meds pull extra fluid from the brain down to decrease ICP
66
TBI Management - surgical management
Evacuate hematoma | Decompressive craniotomy
67
TBI management - surgical management - tier 2 is what
Decompressive craniotomoy - Remove part of cranium to allow brain to swell - place bone flap once edema resolved Usually not done unless all other measures fail
68
TBI management - max swelling usually occurs when
72 hours is usually when it peaks and it can last 1 to 2 weeks
69
TBI management - Reduce cerebral metabolic demands
Tier 2 Induced hypothermia Barbituate coma to reduce brain activity
70
Systems management
``` Stable electrolytes and blood sugar Stress ulcer prophylaxis Anticonvulsants to prevent seizures Venous thrombosis prophylaxis Nutrition Skin breakdown prevention Bowel and bladder regime Tracheostomy Social ```
71
Complication
Sepsis Renal failure Pulmonary failure
72
Predicting outcome
``` Duration of unconsciousness Initial GCS CT scan results ICP results Pupillary response Age of patient ```
73
Long term neurobehavioral sequela
Cog deficits Bx and personality changes Psychiatric disorders

Semester 5 PMNM Exam 7 (7 decks)

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