traumatic brain injury

TBI leading cause of _____ in the US

injury related to death

TBI =

alteration in brain func due to an external source

most common cause of TBI

fall

risk of TBI

• older adults > ____ yrs

• _____

• older adolescents (____-____ yrs)

75, infants, 14, 24

primary brain injury: ____ forces that cause brain tissue to make ____ with an object 

rapid ____ and ____ forces 

external, direct contact, acceleration, deceleration 

secondary injury: changes compromising brain ____ in the hours, days and weeks following _____

function, initial injurt

focal injury: localized to the area of the brain under the _____

site of impact

types of focal injuries

hematoma, contusion, laceration

hematoma: 

collection of blood in one of the several layers of the brain 

contusion:

bruise of brain tissue caused by small blood vessel leaks

laceration

tearing of neural tissue

types of hematoma

epidural, subdural, intracerebral

epidural hematoma 

• ____ bleeding between ____ and ____

• associated with ____ 

• causes rapid increase of ____

arterial, dura, skull, skull fx, ICP 

subdural hematoma

• rupture of ____ between _____ and _____

• associated with ____ without ____

veins, dura, arachnoid, trauma, skull fx

intracerebral hematoma

• common in ____ or ____ lobes

• mod to severe

frontal, temporal

most common areas of contusion

frontal and temporal lobes

_____ occurs most often with MVAs 

contusion 

injury resulting from an explosive device

blast injury

blast injury - primary injury: transient ____

shock wave

blast injury - secondary injury: ____

shrapnel

blast injury - tertiary injury: victim is ____

flung backward 

sequelae of TBI

cognitive, neurobehavorial, neuromscular, communication, swallowing, activity limitations, participation restrictions, dysautonomia, post traumatic seizures

overactivation of sypathetic nervous system

dysautonomia

coma = eyes _____, _____ sleep/wake cycles, ____ dependent

closed, no, ventilator

vegetative state = eyes _____, ______ sleep/wake cycles, absent awareness of _____/_____/_____

withdrawal to _____

open, has, surroundings, meaningful cognitive function, communication

vegetative state is characterized as

unresponsive wakefullness

minimally conscious state: some evidence of ____ awareness, inconsistent ____ movements, will ____ to simuli

self or environmental, volitional, localize

measures level of arousal 

glasgow coma scale 

flexor posture

decorticate

extensor posture

decerebrate

motor response from best to worst

localized to pain, withdraws to pain, decorticate, decerebrate, flaccid

loss of consciousness 

mild = 

mod = 

severe = 

0-30min, >30min, <24hr, >24 hr 

alteration of consciousness

mild = 

mod = 

severe = 

brief to >24 hr, >24 hr, 24 hr

post traumatic amnesia

mild = 

mod = 

severe = 

0-1day, >1 <7 days, >7 days

secondary complications of TBI

• _____

• _____ ossificans

• ____ ulcer

• _____

• _____ pain

• _____

• decreased ____

• muscle ____

• _____

• _____ nerve damage

DVT, hetetrophic, pressure, pnuemonia, chronic, contractures, endurance, atrophy, fracture, peripheral

early medial management 

• stabilize ____ and ___ systems 

• minimize _____ injury 

cardiovascular, respiratory, secondary 

goals of early medical management

• systolic BP > ____ mmHg

• SpO2 >____%

• ICP <____mmHg

• cerebral perfusion pressure > ____ mmHg

90, 90, 20, 60

Rancho Los Amigos LOCF - pt appears in deep sleep and completely unrepsonsive

1 - no response

Rancho Los Amigos LOCF - reacts inconsistently and nonpurposefully to stimuli

2 - generalized response

Rancho Los Amigos LOCF - pt reacts specifically but inconsistently to stimuli 

3 - localized response

Rancho Los Amigos LOCF - pt is heightened state of activity, behavior is bizzare and non purposeful

4 - confused agitated

Rancho Los Amigos LOCF - pt able to respond to stimuli commands fairly consistently

5 - confused inappropriate

Rancho Los Amigos LOCF - pt showas goal directed behavior but depends on external input or direction

confused appropriate

Rancho Los Amigos LOCF - pt appears appropriate and oriented within hospital and home settings 

automatic and appropriate 

Rancho Los Amigos LOCF - pt is able to recall and integreate recent evetns and is aware of and responsice to environment

purposeful appropriate

special considerations for confused anfd agitated patients

• ____ is important

• create ____ environment

• maintain ___ and stay ___

• be flexible to pts ___

• allow ____ periods

consistency, safe, composure, clam, lability, rest

early assisted mobilization

• improved likelihood of ____

• reduce risk of ____

• improved ____

• shorten ____

home d/c, secondary complications, outcomes, length of stay

contraindications to early mobilization 

unstable spine, increased ICP 

precautions to early mobilization

• ____ restrictions

• ____ integrity

• ____ instability

• _____ status

WB, skin/joint, autonomic, cardiovascular

negative prognostic factors

• low initial ____

• age, race, lower edu level

• initial ____ evidence of hemorrhage, subarachnouc bleed, subdural hematoma, etc

GCS, CT