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Clin Med 2 > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

How often does someone die from a head injury or is permanently disabled?

A

Every 5 motha fuckin minutes

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2
Q

What is the most common mechanism of injury for a TBI?

A

MVA–50% of all injuries; followed by falls, and violence

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3
Q

What are the risk factors for TBI above the age of 65? (5)

A
  • female
  • poor vision
  • hx of previous falls
  • dementia
  • polypharmacy (over medication or increase in meds)
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4
Q

What is the definition of a closed head injury (CHI)?

A

non-penetrating of the meninges in head injuries

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5
Q

What is an example of a closed head injury?

A

Concussion

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6
Q

What may we see in some closed head injuries? (6)

A
  • brainstem damage
  • contusions
  • diffuse white matter lesions
  • injury to blood vessels
  • damage to cranial nerves
  • CSF rhinorrea
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7
Q

What is the definition of a open head injury (OHI)?

A

A penetrating head injury where the meninges have been breached

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8
Q

True/False:

Open head injuries may be caused by accelerating or decelerating forces

A

True

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9
Q

True/False:

The amount of damage in open head injuries is due to the areas affected

A

True

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10
Q

What type of head injury would a gun shot wound be?

A

A fucking open head injury

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11
Q

What is associated with skull fractures? (5)

A
  • increased risk of infection
  • TBI
  • meningitis
  • encephalitis
  • abscess
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12
Q

True/False:

Not all skull fx result in head injury, but ALL increase risk of infection

A

True

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13
Q

When does primary injury occur?

A

At the time of impact

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14
Q

When does secondary injury occur?

A

After the time of impact secondary to the body’s response to injury

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15
Q

What is local brain damage?

A

Damage that is localized to the area of the brain under the site of impact on the skull

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16
Q

What is the likely MOI for local brain damage?

A

Direct contact

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17
Q

What is polar brain damage?

A

Brain moves forward inside the skull, suddenly stops due to impact with the skull; damage occurs only on one side of the brain.

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18
Q

What is a diffuse brain injury?

A

Diffuse axonal injury

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19
Q

What is the likely MOI of a diffuse brain injury?

A

non-contact, acceleration/deceleration or rotational forces

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20
Q

What is a coup-contrecoup injury?

A

It is a brain injury that occurs on both poles of the brain.

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21
Q

What does coup mean?

A

It is the pole of the brain where the 1st injury takes place. Under the site if contact with the head

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22
Q

What does contrecoup mean?

A

Is the damaged cause by the brain ricocheting off the back of the skull, the opposite pole of the brain. The 2nd injury site.

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23
Q

When do we commonly see coup-contrecoup injuries?

A

Whiplash injuries

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24
Q

Can secondary injury be more life threatening then the primary injury?

A
  • yes sir
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25
Q

What is hypoxic-ischemic injury?

A

due to insult to specific vascular territory due to brain shift, or diffuse injury caused by arterial hypoxemia.

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26
Q

What can be commonly seen with secondary injury? (4)

A
  • intracranial hematoma
  • mass effect
  • increased intracranial pressure
  • hydrocephalus
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27
Q

What is the mass effect?

A

shift of brain caused by edema

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28
Q

What can increased cranial pressure cause?

A

it can compress and compromise blood vessels

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29
Q

What are some causes of secondary injury? (6)

A
  • neurochemical and cellular changes
  • hypotension
  • hypoxia
  • increased ICP which leads to decreased CPP (cerebral perfusion pressure)
  • electrolyte imbalances
  • ischemia
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30
Q

What does a hematoma or clot create in the brain?

A

bleed creating the mass effect

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31
Q

Where is a intracranial hemorrhage?

A

inside the brain

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32
Q

What is vasoparalysis?

A

An arrest in circulation with instantaneous rise in ICP

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33
Q

What causes shearing forces?

A

A blow to the cranium causing rotation of the brain within the skull

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34
Q

What does does shearing forces lead to?

A

to diffuse axonal injury

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35
Q

What do contusions lead to?

A

hemorrhage and increase in ICP

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36
Q

What do lacerations cause?

A

Direct damage to neural tissue

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37
Q

When are shear injuries commonly seen?

A

In acute injuries due to the differences between gray and white matter. When you stop quickly, these layers will seperate

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38
Q

Where do the white and gray matter usually separate?

A

typically at cortico-medullary junctions

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39
Q

What is the prognosis for shear injuries?

A

Poor

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40
Q

What is an immediate complication of a head injury?

A

Edema

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41
Q

What is vasogenic edema?

A

it occurs in regions bordering those damaged during ischemia

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42
Q

What is cytotoxic edema?

A

it follows cerebral ischemia or hypoxia; caused by swelling of endothelial cells, neurons and glia

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43
Q

Does cytotoxic edema cause physical damage or damage because of lack of blood supply in cells?

A

lack of blood supply

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44
Q

What is the most common form of edema?

A

vasogenic edema

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45
Q

What is diffuse cerebral edema?

A

swelling/damage throughout the brain

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46
Q

What are other immediate problems in the brain? (2)

A
  • herniation

- infection

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47
Q

What causes herniation?

A

increased pressure in the brain

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48
Q

What is the most appropriate diagnostic imaging of a head injury in the ER?

A

CT scan

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49
Q

What imaging detects cerebral blood flow mapping?

A

PET or SPECT scan

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50
Q

What are the 5 ways to image the head?

A
  • x-ray
  • CT scan
  • MRI
  • PET or SPECT
  • EEG
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51
Q

What does the glasgow coma scale define?

A

level of consciousness after suspected brain injury

52
Q

What is the neurosurgical definition of a coma?

A

no eye opening, no recognizable speech, no following of motor commands

53
Q

What are the 3 things that the Glasgow coma scale assess?

A

1) eye opening - 4pts
2) motor responses - 6pts
3) verbal responses - 5pts

54
Q

What is the min/max score you can get on the Glasgow coma scale?

A 
3= min
15= max
55
Q

True/False:

The higher the better on the glasgow coma scale

A

Ture, 15=best

56
Q

True/False:

The lower the worse on the glasgow coma scale

A

True, 3= worse

57
Q

What does scores between 13-15 represent on the GCS?

A

mild brain injury

58
Q

What does scores between 9-12 represent on the GCS?

A

moderate brain injury

59
Q

What does scores 8 or less represent on the GCS?

A

severe brain injury

60
Q

What is common with Minor head injuries?

A

anterograde/retrograde amnesia

61
Q

True/False:

Minor signs and symptoms may progress to more serious pathologies

A

True

62
Q

What are the most common complaints with minor head injury? (4)

A
  • seeing stars
  • stunned
  • nervous
  • poor memory of events just prior to or just following the event
63
Q

What is a concussion?

A

a violent jarring or shaking that results in a temporary disturbance of brain function

64
Q

True/False:

A concussion is a mild form of diffuse axonal injury

A

True

65
Q

True/False:

A concussion is a momentary interruption of the brain function with or without loss of consciousness

A

True

66
Q

Do microscopic changes occur in neurons and glia within hours of a concussion?

A

Yes

67
Q

True/False:

Return to play guidelines vary between sports/leagues

A

True

68
Q

What are return to guidelines monitored by?

A

IMPACT testing

69
Q

Does the patient need to be symptom free before he can return?

A

yesss

70
Q

What are the 5 symptoms that are involved in post-concussion syndrome?

A

1) persistence of imld symptoms such as headaches, irritability, insomnia, poor concentration/memory
2) persist for weeks or months
3) organic basis
4) limit ability to complete ADLs or employment
5) may need cognitive retraining or psychological support

71
Q

What are the 5 types of moderate head injury?

A

1) acute epidural hemorrhage
2) acute subdural hemorrhage
3) chronic subdural hematoma
4) cerebral hemorrhage
5) subarachnoid hemorrhage

72
Q

How can you describe an acute epidural hemorrhage?

A
  • no initial coma, but deterioration in neuro status if left unresolved
  • resolved with surgical procedures
73
Q

How can you describe an acute subdural hemorrhage?

A
  • results QUICKLY in coma
  • bleed arrested by increased ICP
  • requires surgical intervention
  • happens QUICKLY
74
Q

How can you describe an chronic subdural hematoma?

A
  • SLOW venous leak
  • neuro deterioration over a period of weeks
  • CT scan- encapsulated mass often mistaken as tumor
  • surgical intervention
75
Q

How can you describe an cerebral hemorrhage?

A
  • disruption of intrinsic cerebral circulation

- managed similar to hypertensive stroke

76
Q

How can you describe an subarachnoid hemorrhage?

A
  • managed similar to epidural hemorrhage

- disruption of circulation into the brain

77
Q

Severe head injury presents with immediate

A

loss of consciousness

78
Q

Is there a complete paralysis of cerebral function with a severe head injury?

A

yes

79
Q

What can we see immediately after a severe head injury? (5)

A
  • cerebral lacerations
  • SAH
  • subdural hemorrhage
  • coup-contrecoup sites
  • damage along the line of force
80
Q

True/False:

There will be multiple systems involved in a severe head injury

A

true

81
Q

True/False:

Permanent deficits will persist after a severe head injury

A

true

82
Q

How do you define, incompatible with life? (7)

A
  • deep coma
  • initially may be flaccid, become spastic or rigid with posturing
  • unresponsive to pain and all stimuli
  • ventilator required to maintain breathing
  • deregulation of body temperature and BP
  • poor EEG
  • brain dead
83
Q

What is brain dead?

A

The in capatable with life criteria must be present for 30 minutes at least 6 hours after onset of coma and apnea

84
Q

What are the 4 criteria of brain death?

A

1) coma with cerebral unresponsivity
2) apnea- no spontaneous respiration
3) absent cephalic reflexes- like pupils etc
4) electrocerebral silence

85
Q

What is the acronym PVS mean?

A

Persistent Vegetative State

86
Q

What does it mean to be in PVS?

A

wakeful, reduced responsiveness with no evident cerebral cortical function

87
Q

How long is the life expectancy with patients with PVS?

A

weeks, months, years

88
Q

What is the prognosis for a patient in PVS longer then 3 months?

A

Poor

89
Q

What can you usually see in a patient in PVS? (5)

A
  • posturing
  • some movement
  • no communication
  • tube feeding
  • uses reflexes for movement
90
Q

What is shaken baby syndrome?

A

Trauma to the brain of a small child or infant due to repetitive shaking

91
Q

Is shaken baby syndrome considered child abuse?

A

unfortunately yes

92
Q

What type of brain damage is seen in shaken baby syndrome?

A

polar brain damage

93
Q

True/False:

Occipital damage will have visual deficits

A

True

94
Q

What is the definition of near drowning?

A

Surviving 24 hrs or longer after the physiologic effects of hypoxemia and acidosis from submersion in fluid

95
Q

What is dry drowning?

A

inhalation of little to no fluid with minimal lung injury–laryngeal spasm

96
Q

What is wet drowning?

A

Aspiration of fluid into the lungs–asphyxia

97
Q

Does respiratory distress occur after a near drowning incident?

A

you’re damn right it does

98
Q

What is the second leading cause of death in people under 15 years of age?

A

Near drowning

99
Q

What are the risk factors of near drowning? (6)

A
  • alcohol consumption
  • seizure disorder
  • MR
  • MI
  • head or spinal cord injury at time of accident
  • failure to use floatation device
100
Q

What determines near drowning pathological events?

A

duration of submersion and temperature of water

101
Q

What does hypoxia lead to?

A

global cell damage

102
Q

How long until neurons and cardiopulmonary cells suffer irreversible damage?

A

4-6 minutes in neurons

up to 30 minutes for cardiopulmonary cells

103
Q

What does the clinical picture and prognosis of near drowning depend on?

A

extent and duration of hypoxic event

104
Q

What is the least reversible complication of near drowning?

A

neurological injury

105
Q

True/False:

Cerebral edema secondary to injury may cause increased ICP which leads to reduction of cerebral blood flow

A

True

106
Q

What are the cognitive problems associated with TBI? (6)

A
  • memory
  • Attention
  • Concentration
  • Communication
  • Reasoning
  • Impaired Judgement
107
Q

What was the Rancho scale first known as?

A

Levels of cognitive functioning

108
Q

What was the Rancho scale developed for?

A

as a way to describe the stages of cognitive improvement as a person with brain injury becomes more responsive.

109
Q

Is the Rancho scale a test?

A

nope, it’s a method of organizing and describing observations in a generalized way to help communicate with families.

110
Q

True/False:

Rancho Los Amigos Levels of cognitive functioning has an element of predictability

A

truth

111
Q

Improvement through the the Rancho scale depends on what?

A

upon the extent and severity of the brain injury

112
Q

How many levels are part of the Ranchos Los Amigos Levels of Cognitive Function?

A

10 levels

113
Q

What describes level I on the scale?

A

no response to pain, touch, sound or sight

114
Q

What describes level II on the scale?

A

generalized reflex response to pain

115
Q

What describes level III on the scale?

A

localized response; blinks to strong light, turns toward/away from sound, responds to physical discomfort, inconsistent response to commands

116
Q

What describes level IV on the scale?

A

Confused/agitated; alert, very active, aggressive or bizarre behaviors, performs activities but behavior is non-purposeful, extremely short attention span.

117
Q

What describes level V on the scale?

A

Confused/non-agitated; gross attention to environment, highly distractible, requires continual redirection, difficulty learning new tasks, agitated by too much stimulation. may engage in social conversation.

118
Q

What describes level VI on the scale?

A

Confused/appropriate; inconsistent orientation to time and place, retention span/recent memory impaired, begins to recall past, consistently follows simple directions, goal orientated behaviors with assistance

119
Q

What describes level VII on the scale?

A

Automatic/Appropriate; performs daily routine in highly familiar environment in a non-confused but automatic robot-like manner. Skills noticeably deteriorate in unfamiliar environment. Lacks realistic planning for own future.

120
Q

What describes level VIII on the scale?

A

purposeful/appropriate

121
Q

What describes level IX on the scale?

A

purposeful, appropriate: stand-by assistance-on

122
Q

What describes level X on the scale?

A

purposeful, appropriate: modified independent.

123
Q

The clinical picture of TBI in the physical/movement stand point? (9)

A
  • speech problems
  • vision problems
  • hearing problems
  • headaches
  • sensory problems.losses
  • loss of coordination
  • muscle tone changes (25% of patients)
  • seizures
  • sleeping problems
124
Q

The clinical picture of TBI in the social stand point? (4)

A
  • fatigue
  • anxiety
  • depression
  • emotional instability
125
Q

What are the 4 immediate medical management techniques of TBI?

A

1) preservation of life - ABCs
2) ICP, infection, nutrition
3) Determination of severity of injury
4) Prevention of further damage

126
Q

What are the 5 medical complications associated with TBI?

A

1) post-traumatic seizures
2) hydrocephalus
3) DVT
4) Heterotopic ossification
5) GI/GU issues

Clin Med 2 (5 decks)

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