TBI, Coma, Rancho Quiz 3

Acquired brain injury

damage to the brain acquired after birth

Traumatic injury

caused by physical external force

non-traumatic injury

caused by non-traumatic internal or external force

Examples of non-traumatic

stroke, tumor, toxins, virus, lack of oxygen, etc.

Coup injury

primary, brain strikes skull on side of impact

Contrecoup injury

secondary, brain strikes posterior area of skull

Diffuse axonal injury

50% of severe TBIs, brain moves back and forth in skull as a result of acceleration and deceleration

How many are living in the US with long-term disability from TBI

3.5 million

What ages are most affected

children, older adolescents, and 65+

After 1 TBI

3 times greater chance for a second TBI

After 2 TBIs

8 times greater chance for a third TBI

Primary consequences of TBI

at time of impact, mechanical deformation causes this

Examples of primary consequences

contusions, lacerations, diffuse injuries, shearing of cranial nerves, tearing of pituitary stalk

Secondary consequences of TBI

Delayed hours to weeks, root of long-term deficits

Examples of secondary consequences

Intracranial hemorrhage, edema, neuro-chemical events leading to neuronal death

Normal ICP

0-10 mm Hg

ICP>20

abnormal

ICP>40

neurological dysfunction and impairment of electrical activity

ICP>60

Fatal

Precautions for EVD

zero line is placed at level of ear

EVD stands for

external ventricular drain

Concussion or mild TBI

mental confusion has resolved within 24 hrs, LOC less than 30 minutes, 85% of TBIs

Grade 1 mild TBI

transient confusion, no LOC, cognitive symptoms<15 minutes

Grade 2 mild TBI

signs similar to grade 1, no LOC, cognitive symptoms>15 min

Grade 3 mild TBI

definite LOC

Frontal lobe function

motor execution, emotions/inhibition, expressive language(brocas), executive function, working memory

Parietal lobe function

tactile reception/recognition and visual-spatial functions (R) Praxis and motor sequencing (L>R)

Occipital lobe function

Visual reception(shapes and colors)

Cerebellum function

coordination of movement

Brainstem

Breathing, BP, arousal/wakefulness

Temporal lobe

emotion (humor), memory, visual memory (R), verbal memory (L), interpretation of music, receptive language (Wernickes)

Left hemisphere controls

movement of right side, reasoning, speaking, writing, number skills

Right hemisphere controls

movement of left, insight, imagination, musical ability/interpretation, creative skills, awareness of 3 dimensions

Contusion

direct impact to the head, bruise, large ones require surgery

Laceration

tearing of surface tissues of brain

Hematoma

accumulation of blood

Epidural

between dura and skull

Subdural

Between dura and arachnoid

Subarachnoid

between arachnoid and pia

intracerebral versus petechial

bleeding within brain versus small spots in the brain

Coma

not awake or aware, <8 GCS, no sleep/wake cycle, closest to death

Unresponsiveness wakefulness

awake but not aware, chronic VS, autonomic functions working, non-purposeful movements

Minimally conscious state

awake, emerging awareness, >12 GCS, emerging awareness plus eye contact, simple but purposeful command following/behaviors (not always spoken)

Drug-induced coma

deep state of unconsciousness, which allows brain to rest and decrease swelling

Posturing on glascow coma scale

Flexes UE and extends LE and/or extends all extremities in response to pain

Glascow coma scale

3 to 15, indicates severity of brain injury

Passy Muir Valve

allows speech and swallow, weaning step towards a “closed system”

Mild GCS score

13-15

Moderate GCS score

9-12

Severe GCS score

less than or equal to 8

Poor Prognosis based on GCS

(Between field and ER)

initial score of 3-5 with no improvement or deterioration of score by 2 or more points

Better prognosis factors

<65 years, coma<4 weeks, location of injury, command following before 28 days

Galveston Orientation and Amnesia Test (GOAT)

Assess pre, post, and time of injury memory function (76+ on 3 consecutive occasions=PTA resolution)

Post-traumatic amnesia

unable to process new information

Retrograde amnesia

unable to recall information prior to TBI

GOAT score range

-3 to 100

Coma recovery scale

most widely used, reflects brainstem, subcortical, and cortical processes

Disability rating scale

tracks individual from coma to community, addresses all 3 WHO categories

3 WHO categories

impairment, disability, handicap

Coma/near coma scale

measures small clinical changes in patients with severe brain injuries who function at very low level characteristics of near and full vegetative states.

Coma/near coma scale indicate

severity of sensory, perceptual, and primitive responses

Warning signs of sensory overload

flushing, sweating, increased respiration, agitation, closing of eyes, decrease in arousal, increase in muscle tone