Traumatic Brain Injury

Front 1

What does TBI stand for?

Back 1

HAHA if you missed this drop out.

-Traumatic Brain Injury

Front 2

Males and females are equally likely to obtain a TBI?

Back 2

-FALSE:
-Men are more stupider.

Front 3

T or F:
A TBI is defined as a brain injury which results in diminished or altered consciousness, and impaired cognitive and physical abilities.

Back 3

FALSE:
-it does not have to be both cognitive AND physical. It can be either OR both.

Front 4

What is the leading cause of TBI in youth/adolescents? Older population?

Back 4

-Falls/MVA
-Older: Falls

Front 5

A diffuse axonal injury is another name for what?

Back 5

-Concussion

Front 6

What type of forces cause diffuse axonal injuries (concussion)?

Back 6

-Caused by rotational forces, such as with a car accident.
-Caused by shearing forces that affect axons during ACC/DCC of brain; affects neurons of the reticular activating system;

Front 7

A _____________ is defined as an alteration of mental status due to biomechanical forces affecting the brain.

Back 7

-Concussion

Front 8

Concussion symptons?

Back 8

Front 9

What are the six stages of returning from a concussion?

Back 9

1) No activity
2) Light aerobic activity
3) Sports-specific activity
4) Non-contact drills
5) Full contact practice
6) Return to play

Front 10

What is the basic definition of a Contrecoup injury?

Back 10

-An injury where the brain bounces off both the front and back of the skull.

Front 11

A _________________ hematoma occurs between the skull and duramater.
-T or F:
This is a medical emergency?

Back 11

-Epidural Hematoma
-TRUE: this is a medical emergency due to the rapid increase of ICP

Front 12

Executive Function and decision making are performed in which lobe?

Back 12

-Frontal lobe

Front 13

Balance, Coordination and Visual, are performed in which lobe?

Back 13

-Cerebellar

Front 14

Subdural hematomas are often associated with __________ trauma.

-With or without skull fracture??

Back 14

-BLUNT trauma

-WITHOUT skull fracture

Front 15

Penetration Injury:

Back 15

If you dont know this, again stop right now and leave. Just GO HOME.

Front 16

KEGEL QUESTION:

-What is the normal range of intracranial pressure and what is considered increased intracranial pressure?

Back 16

0-10 mmHg

Front 17

What is considered increased ICP?

Back 17

>20 mmHg for >/= 5 min.

Front 18

Cardinal S/S of increased ICP include? (4)

Back 18

1) Headache,
2) Papilledema with retinal hemorrhages,
3) Vomiting, and eventually
4) Drowsiness, progressing to coma and death.

Front 19

_____________: metabolic defect resulting in swelling of brain cells (i.e., intracellular edema)

Back 19

-Cytotoxic Edema

Front 20

What type of brain herniation pushes on the midbrain medially.

Back 20

-Uncal Herniation- herniation of uncus of temporal lobe

Front 21

This type of herniation pushes the midbrain and pons downward?

Back 21

-Transtentorial Herniation- herniation of midbrain and pons

Front 22

What type of herniation pushes through the foramen magnum?

Back 22

-cerebellar tonsillar herniation

Front 23

Name the Herniation:

Back 23

cerebellar tonsillar herniation

Front 24

Name the Herniation:

Back 24

-Transtentorial
-Uncal

Front 25

Name 3-4 S/S of moderate > severe head injury.

Back 25

-CSF coming out of the ears or nose
-Loss of consciousness
-Dilated or unequal pupils
-Loss of eye movement
-Respiratory failure
-Weakness or numbness in the extremities
-Repeated nausea or vomiting
-Inability to awaken from sleep
-Persistent Headache
-Increased confusion or agitation
-Convulsions or seizures
-Slurred speech

Front 26

T or F:
Patients in a coma are able to respond to some stimuli at certain times?

Back 26

FALSE: person cannot be aroused and does not respond to any type of stimulation.

Front 27

What are the four levels of a coma?

Back 27

1) Comatose and Unresponsive State
2) Comatose but Responsive State
3) Conscious but Unresponsive State
4) Conscious and Responsive State

Front 28

Which State?
-Patient is able to see, hear, touch, taste, and/or smell but is unable to respond.

Back 28

Conscious but unresponsive state

Front 29

Which State?
-pt. responds to sensory stimulation with increased HR or breathing rate, facial expressions, or body movements.

Back 29

-Comatose but responsive

Front 30

KEGEL QUESTION:
What is the difference between coma and a persistent vegetative state?

Back 30

A coma last only weeks while a vegetative state may last months >years.

Front 31

A patient with a glasgow score of 10 has a ____________ head injury.

Back 31

-Moderate

-Mild head injury (GCS 13-15)
-Moderate head injury (GCS 9-12)
-Severe head injury (GCS 8 or less)

Front 32

List 3 of the 4 guidelines to determine the need for ICP monitoring.

Back 32

-GCS of 3-8
-Age over 40
-Posturing position (decorticate/decerebrate)
-systolic BP less than 90 mmHg

Front 33

Which type of ICP monitoring is inserted directly into the ventrical?

Back 33

-ICP ventricular monitor

-Allows withdrawal of CSF for treatment of high ICP

Front 34

_______________ is calculated as the difference between the mean arterial pressure (MAP) and the ICP

Back 34

-Cerebral perfusion pressure (CPP)

-CPP value of 70mmHg considered adequate; MAP should be  90 mmHg.
-CPP < 40 to 50mmHg causes ischemia.

Front 35

_________________ agonist affects memory.

Back 35

-Acetylcholine agonist

Front 36

T or F:
Dopamine increases arousal?

Back 36

TRUE

Front 37

The heads up posture requires the head to be at ______ degrees while in the bed.

Back 37

-30 degrees

Front 38

An abnormal flexion posture is known as _____________.

Back 38

-Decorticate

-injury between cortex and red nucleus

Front 39

People with _____________ _____________damage use poor judgment and have difficulty conforming to social conventions.

Back 39

-Orbitofrontal Cortex

Front 40

Prognosis following a coma is determined by?

Back 40

-Duration of coma
-Severity of coma in the first few hours after the injury
-Duration of post-traumatic amnesia
-Location and size of contusions and hemorrhages in the brain
-Severity of injuries to other body systems sustained at the time of the TBI

Front 41

Glacow Coma Scale score of 9 or above have a ______ chance for recovery of function

Back 41

-Good

-Lower scores are potentially fatal

Front 42

Cognitive memory changes after TBI, can include things such as?
A
M
I
J
S

Back 42

-Attention
-Memory
-Initiation
-Judgement
-Speed

Front 43

Where would you not want to exercise with a patient who has SELECTIVE attention problems?

Back 43

-In a crowded gym,
-They would not be able to focus

Front 44

T or F:
One of the best prognostic tools following a TBI is based on memory loss?

Back 44

TRUE.

Front 45

PTA stands for?

Back 45

Post Traumatic Amnersia

-Inability to lay down memories reliably from one day to the next.

Front 46

What is the inability to recall past memories?

Back 46

-Retrograde

Front 47

T or F:
-A Patient with anterograde amnesia is unable to learn?

Back 47

FALSE:
-They are able to motor learn but not cognitively learn new information.

Front 48

At what time frame is PTA considered severe?

Back 48

-Severe = > 1 day and < 7 days

Front 49

A patient following a TBI patient would be able to learn in which manner?
a) declarative
b) procedural
c) both

Back 49

b) procedural

-They would learn best with a classical conditioning setting. This would require excessive repetition and structure.

Front 50

What is commonly the most difficult change for a family to overcome?

Back 50

-The personality and behavioral changes.

Front 51

List 2 common conditions we try to prevent in the ICU setting, following a TBI?

Back 51

-Skin breakdown
-Contractures
-Other injuries

Front 52

T or F:
-Serial casting is when the extrimity is put in a stretch for an extended period of time.

Back 52

FALSE:
-You do not stretch the limb. It is placed at end range.

Front 53

What must be done between castings to improve joint lubrication?

Back 53

-Joint Mobs in a low grade.

Front 54

Splints with a spring are known as _____________ _______________.

Back 54

-Dynamic Splints

Front 55

What is one of the leading problems with Dynamic splints?

Back 55

-The are prone to skin breakdown because they are not total contact splints

Front 56

What Rancho level is known to be aggressive?

Back 56

Level 4

Front 57

The "coma level" for Rancho patients is Lever ___- ___.

Back 57

-1-3
-Coma is defined as unresponsive to external stimuli

Front 58

A patient who is completely unresponsive to any stimuli is a level ___?

Back 58

-Level 1

Front 59

A patient who reacts specifically but inconsistently to stimuli is level ____?

Back 59

-Level 3

Front 60

A patient whos responses are limited & often the same regardless of stimulus presented is most likely a level ___?

Back 60

-Level 2

Front 61

Heterotopic Ossification is what?

Back 61

-Abnormal bone growth in muscle and other areas.

Front 62

Why is removal of heterotopic ossification's delayed initially?

Back 62

-If it is removed too early it is very likely to return.

Front 63

A patient who is in a heightened state of activity and demonstrating behavior that is bizarre and non-purposeful relative to immediate environment is most likely a Level ___?

Back 63

-Level 4

-AGITATED

Front 64

What is a normal treatment time span for a Rancho level 4?

Back 64

-Normally bouts of approx 15 min.

Front 65

This Rancho level is described as Confused-Appropriate?

Back 65

-Level 6

Front 66

T or F:
Goals for levels 5-6 include motor goals, but no safety and judgement goals?

Back 66

TRUE:
They are able to motor learn, but not yet able to assess situations and use selective judgement for safety.

Front 67

What type of questions would you ask a level 5-6 patient?

Back 67

-"do you want THIS or THAT"

-NO "yes/no questions"

Front 68

__________ is the inability to stop ones self from performing something that may not be appropriate.

Back 68

-Disinhibition

Front 69

___________ is when you start something and keep repeating it or inability to change off subject.

Back 69

-Preservation

Front 70

This Rancho level is defined as Automatic - Appropriate?

Back 70

-Level 7

Front 71

This Rancho level patient is able to recall and integrate past and recent events and is aware of and responsive to the environment. They show carryover for new learning and needs no supervision once activity is learned?

Back 71

-Level 8

Purposeful - Approprite

Front 72

At what Rancho level might you consider independence a goal?

Back 72

-Level 8

Front 73

What is "punch drunk syndrome"?

Back 73

-This is the cumulative effect of multiple concussions/TBIs.

-Common in boxing/MMA

Front 74

When compared to a TBI, who has a worse prognosis, TBI or axonic brain injury?

Back 74

-Axonic Brain Injury

Front 75

What is an Axonic Brain Injury?

Back 75

-Secondary to incidents that alter the amount of oxygen in the blood or alters amount of cerebral perfusion for a period of time

Front 76

These are two drugs KEGEL had listed so I may want to know:

Back 76

-Nimbex – skeletal muscle relaxant for spasticity
-Deprovan – anaesthetic