Traumatic Brain Injury

what is the most common cause of death and disability among young people?

TBI

who are more likely to sustain a TBI?

males

acquired brain injury

includes all brain injuries required AFTER birth; can be internal or external factors

traumatic brain injury examples

concussion, skull fx, fall, MVA, bullet

nontraumatic brain injury examples

stroke, tumor, disease, lack of oxygen

what are the leading causes of TBI?

MVA, violent acts, falls

other common causes include sporting injuries or military blasts

traumatic brain injury

alteration in brain function caused by an external force

closed TBI

caused by an external force that produces movement of brain within the skull, but is nonpenetrating

open TBI

foreign object entered the skull to cause damage; penetrating injury

how long is the recovery process for an acquired brain injury?

lifelong

a patient lost consciousness for 15 minutes and had posttraumatic amnesia for less than 6 hours. what classification of TBI did they sustain?

mild

a patient with a mild TBI would have a Glasgow scale of what?

13-15

a patient sustained a blow to the head and was unconscious for 5 hours. they woke up showing signs of posttraumatic amnesia and disorientation. what would their Glasgow scale be?

9-12

a severe TBI is characterized by what?

loss of consciousness for over 24 hours, posttraumatic amnesia for more than 7 days, disorientation and confusion

what classification of TBI is a Glasgow scale of 3-8?

severe TBI

what are the three categories of the Glasgow coma scale?

eye opening, motor response, verbal response

focal brain injury

direct blow to the head after contact with an external object or fall, penetration injury from weapon, collision of brain with inner parts of the skull

diffuse brain injury

happens when brain rapidly shifts inside the skull— injury occurs during acceleration/deceleration

diffuse axonal injury

injury where brain accelerates, decelerates, and rotates inside the skull, causing cerebrum to rotate around the brain during impact. typically causes injury to many parts of the brain

a patient presents with ataxia, diplopia, and dysarthria. what type of brain injury did they sustain?

diffuse

diffuse injuries often damage what part of the brain?

brainstem and cerebellar pathways

primary phase of TBI

results in damage to axons and blood vessels

secondary phase of TBI

axonal swelling, loss of axonal transport, altered neurotransmission, loss of neuronal function, apoptosis, necrosis and neuronal demyelination

concussions

often referred to as mild TBI, but can be moderate-severe; characterized by immediate and transient alteration in brain function including mental status and level of consciousness

timmy roo was playing playing rugby and bashed his head with another players. timmy roo did not lose consciousness and does not have any external signs of head trauma. he couldn’t remember what happened immediately before the blow and was confused upon sitting up on the field. since then, he has had trouble concentrating and has had changes in balance and coordination. what would be timmy roo’s predicted diagnosis?

concussion

a patient is in the acute phase of TBI survivorship. what is the goal of this phase?

minimize brain swelling

in what phase of TBI survivorship does the patient receive education?

• intensive phase

• survival phase

• recovery phase

recovery phase

coma

inability to open eyes in response to any stimuli and the absence of the sleep-wake cycle on an EEG reading

which patient would likely leave the individual in a coma?

• diffuse brain injury

• diffuse axonal injury

• concussion

• blast brain injury

• diffuse axonal injury

vegetative state

complete loss of ability to interact with the environment. eyes may be open but there is no evidence of consciousness

minimally responsive

inconsistent abilities to purposely interact with their environment depending on stimuli presented

a patient recovering from a coma who can’t create new memories is in what phase of coma recovery?

phase 1

what is phase 2 of coma recovery characterized by?

cognitive impairment becomes more evident, but confusion clears

a coma emerging patient is uncharacteristically aggressive and agitated. what is the role of the care team during this phase?

• provide patient education

• create a safe environment

• prepare patient for discharge

• create safe environment

what is often used in conjunction with the Glasgow coma scale?

Ranchos los Amigos scale