Traumatic Brain Injury and Coma

Traumatic brain injury (TBI)

Penetration or blow/jolt to the head that disrupts function of the brain

What are the 4 types of brain injury?

external force, severe acceleration + deceleration, blast, penetrating objects + vascular damage

External force

Hitting head hard enough to cause brain movement. Includes with + without skull fracture

Severe acceleration + deceleration

Shaken baby syndrome

Blast injury

Explosion (military)

Penetrating objects + vascular damage

Damaging blood supply to the brain

What does Glasgow Coma Scale do?

Describes level of patient awareness

What’s does a score from 3 to 8 mean on GCS?

Coma, minimal response

What does a score from 13 to 15 mean on GCS?

Slight confusion, can follow demands

If there are contextual factors that prevent assessment what should you document?

Non testable

What setting would require the Glasgow Coma Scale?

Inpatient, acute care setting

What are the 3 domains of the GCS?

Eyes, verbal, motor

What does Ranch Los Amigos Scale (RLAS) do?

Assess cognitive functioning

When would you use RLAS?

Post acute care, rehab

Difference between GSC and RLAS

GSC- initial level of injury + coma

RLAS- information on level/ stage of recovery as patient comes out of coma

What are primary brain damages after brain injury?

• Immediate response to initial injury

• Focal cortical contusion (broken blood vessel: bruise, hemorrhage)

• Diffuse axonal injuries (concussion)

What are Secondary brain damages after brain injury?

Resulting from initial injury (Brain swelling, Ischemia, infection)

What is a coma?

Complete paralysis of cerebral function, state of unresponsiveness

What causes a coma?

Infection, tumor, trauma, seizure

Is Decorticate posturing a positive or negative sign?

Positive sign

Is Decerebrate posturing a positive or negative sign?

Negative sign

Which has a better prognosis… Metabolic problems (digestion of substance) or structural lesions?

Metabolic problems have a better prognosis because doctor can prescribe medication.

With structural lesions there can be tissue that can’t be recovered.