TBI's and SCI's

Question 1

what is a primary injury?

Answer 1

effect on the brain at the time of injury

Question 2

examples of causes of a primary injury?

Answer 2

trauma- contusion, damage to blood vessels, axonal shearing, contusion, epidural/subdural hematoma, SAH, DAI

Question 3

what is axonal shearing?

Answer 3

when the axons of neurons are stretched and torn

Question 4

what is a secondary injury?

Answer 4

complications that result in additional changes and dysfunction of brain tissue
after injury resulting in further damage or even death

Question 5

examples of secondary injuries?

Answer 5

hypoxemia, hypotension, hypo/hyperglycemia, increased metabolic demands, loss of auto regulatory mechanisms, increased ICP, hypo or hypercapnia

Question 6

what is a DAI?

Answer 6

diffuse axonal injury, is a form of TBI

Question 7

when do DAIS occur?

Answer 7

when the brain rapidly shifts inside of the skull as an injury is occurring; the axons in the brain are sheared as the brain accelerates and decelerates inside of the skull

Question 8

what part of the brain do DAI’s occur in?

Answer 8

many parts of the brain

Question 9

what happens to most patients with a DAI?

Answer 9

comatose state

Question 10

how is clinical presentation assessed?

Answer 10

using the GCS

Question 11

what GCS score indicates a mild TBI?

Answer 11

13-15

Question 12

what GCS score indicates a moderate TBI?

Answer 12

9-12

Question 13

what GCS score indicates a severe TBI?

Answer 13

<8

Question 14

what might a mild TBI cause?

Answer 14

functional deficits weeks or months following injury

Question 15

What might we be able to see on a CT?

Answer 15

hematomas, bleeding, fractures, cerebral edema

Question 16

what might we be able to see on an MRI?

Answer 16

DAI, brain stem injury, traumatic aneurysms

Question 17

what does management of TBIs focus on?

Answer 17

optimizing functional recovery and prevention of secondary injury

Question 18

things assessed and monitored to prevent secondary injury?(8)

Answer 18

airway
oxygenation
ventilation 
fluid management
ICP
cerebral perfusion
preventing increased cerebral oxygen demand
preventing complications

Question 19

ways to support cerebral perfusion?

Answer 19

pressors:
dopamine
levo
neosynephrine
epinephrine
EEG

Question 20

what are some examples of secondary complications?

Answer 20

pneumonia
PE
DVT
skin integrity

Question 21

Ways to prevent secondary complications?

Answer 21

blood thinners
lung assessments
oral care
q2h turns

Question 22

what are some examples of skull fractures?(3)

Answer 22

linear
depressed
basilar

Question 23

what is a linear fracture?

Answer 23

generally not displaced, a hairline fracture

Question 24

what is the treatment for a linear fracture?

Answer 24

no tx needed

Question 25

what is a depressed fracture?

Answer 25

inward depression of bone fragments

Question 26

what is a treatment for a depressed fracture?

Answer 26

surgery

Question 27

what is the main concern with depressed fractures?

Answer 27

brain damage

Question 28

what is a basilar fracture?

Answer 28

involves the base of the skull | CSF leaks from nose/ears indicates dural tear

Question 29

what is a major indicator of a basilar fracture?

Answer 29

battles sign- bruising behind the ears

Question 30

what is the best way to test for a CSF leak?

Answer 30

pH paper

Question 31

what are the most common causes of SCI's?

Answer 31

- MVA - falls - acts of violence - sports-related

Question 32

what is the most common cause of a SCI?

Answer 32

MVA with 48% resulting from them

Question 33

what is the most common population to get a SCI from a fall?

Answer 33

the elderly

Question 34

what does an SCI result from?

Answer 34

bone, disk material, or foreign object entering the spinal canal and disrupting the spinal cord or blood supply

Question 35

What are the mechanisms of injury for an SCI?

Answer 35

- whiplash (hyperflexion/extension) - axial loading, compression (diving and hitting head) - rotation - penetrating trauma (knife, GSW)

Question 36

types of SCI damage?

Answer 36

- concussion (shaking of brain, spinal cord) - contusion (bruising) - laceration(cut) - transection (severing) - hemorrhage (bleeding out) - blood vessel damage

Question 37

what will you see with secondary injury?

Answer 37

HA, changes in LOC, respiratory fx

Question 38

what is neurogenic shock shown by?

Answer 38

``` MAP, CVP, CPP loss autonomic nervous system influence (T1-L2) decreased HR vasodilation edema ```

Question 39

what is an incomplete SCI?

Answer 39

varying degree of sensory and motor function disruption because some tracts intact

Question 40

what is a complete SCI?

Answer 40

total loss of sensory and motor function below level of injury caused by complete interruption of pathways

Question 41

what is the presentation with neurogenic shock?

Answer 41

hypotension, warm-flushed skin, diaphragmatic breathing

Question 42

treatment for neurogenic shock?

Answer 42

- dopamine - vasopressin - ephedrine - norepinephrine - phenylephrine - atropine

Question 43

what is the first line treatment for neurogenic shock?

Answer 43

phenylephrine

Question 44

what is an example of a muscle relaxant?

Answer 44

cyclobenzaprine

Question 45

what is an example of an anticonvulsant?

Answer 45

levatiracetam

Question 46

what is an example of an antineuropathic?

Answer 46

gabapentin

Question 47

what is autonomic dysreflexia?

Answer 47

a life threatening condition in pts with injury at or above T6

Question 48

what can autonomic dysreflexia precipitate?

Answer 48

seizure or stroke

Question 49

what is autonomic dysreflexia caused by?

Answer 49

unopposed sympathetic response below level of injury

Question 50

when can autonomic dysreflexia occur?

Answer 50

anytime after spinal shock resolves, usually in first year after injury

Question 51

what triggers autonomic dysreflexia?

Answer 51

- over distended bladder - full rectum - infection - pressure sore - pain

Question 52

what is the most common cause of autonomic dysreflexia?

Answer 52

over distended bladder

Question 53

what does the stimulus from causes of autonomic dysreflexia cause?

Answer 53

marked elevation in blood pressure

Question 54

symptoms of autonomic dysreflexia?

Answer 54

- severe HA - nasal congestion - SOB - nausea - blurred vision - facial flushing - diaphoresis - piloerection - anxiety

Question 55

what is the difference between neurogenic shock and autonomic dysreflexia?

Answer 55

shock has hypotension and bradycardia | autonomic dysreflexia is a hypertensive crises