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105 Cards in this Set

  • Front
  • Back
biochemical effects of the trauma on brain and skull
primary injury
complications that result in additional changes and dysfunction of brain tissue
secondary injury
when does primary occur
when you hit your head
cannot be stopped
primary inj
ex of 2ndary inj
- edema
- tissue death
-
generally not displaced, no tx needed
linear fx
inward depression of bone fragments. may require surg
depressed fx
involves base of skull.
basilar fx
what does leakage of CSF from nose or ears indicate
dural tear (basilar fx)
what can skull inj result in
underlying inj to brain tissue
what does a depressed fx cause
pushing against brain tissue and erruption of vessels---bleeding
bleeding behind the ear and raccoon eyes
battlesign
what type of fx does battles sign appear
basilar
result of primary inj (6)
- contusion
- epidural hematoma
- subdural hematoma
- traumatic subarachnoid hemo
- diffuse axonal inj
-concussion
ex of diffuse axonal inj
shaken infant
what does mgnt of 2ndary brain inj focus on
minimizing inj by increasing 02 blood to brain and decreasing cerebral metabolic demands
2ndary brain inj focus is on what (9)
- hypoxemia
-hypotension
-anemia
-hypo-hyperglycemia
-increasedmet demands (fever
- loss of autoregulatory mech
- increased ICP
- hypo-hypercapnia
-biochemical changes
why is it important to not have a decrease in BS
decreases fuel
most important indicator for severity of inj
LOC
Mild TBI
GCS 13-15
moderate GCS
9-12
severe GCS
<8
when does activation of organ donor systemstart
at severe GCS <8
how is LOC assessed
GCS
what can mild GCS score cause
functional deficits wks to mths following inj
what is CT used to identify with brain inj (4)
- hematomas
- other bleeding
-Fx
- cerebral edema
what is MRI used to identify (3)
- DAI
-brain stem inj
- traumatic aneurysms
what should work up of brain inj include
search for other injuries
why do diffuse inj have the worst outcomes
bc its throughout the brain tissue and causes stretching and shearing of axons
what does mgnt of TBI focus on
- optimizing functional recovery by minimizing 2ndary inj
Mgnt for TBi (9)
- airway mgnt
- oxygenation
- ventilation
- F&V mgnt
- ICP mgnt
- supporting cerebral perfusion
- preventing increased cerebral 02 demand
-preventing 2ndary complications (PE, pneum,DVT,Skin integrity)
-family education/support
common causes of SCI (4)
- MVA 48%
-falls 23%
- ACts of violence 14%
- sports related inj 9%
varies with SCI
degree of paralysis and loss of sensation below level of inj
what causes deficits in SCI
-initial inj
-2ndary inj
predominant risk factors for SCI (4)
- young age
-males
- ETOH use
-drug use
% of SCI that occur in males
80
50% of SCI occur in what ages
16-30 yrs
cervical regioin % for SCI
50%
what does SCI result from ____ entering spincal canal and disrupting the spinal cord or blood supply (3)
-bone
-disk material
-foreign object
what are the mechanisms of inj for SCI (5)
- hyperflexion
- hyperextension
- axial loading/compression
- rotation
- penetrating trauma
what is the most freq penetrating trauma for SCI
GSW
temp loss function
concussion
bruising including bleeding into cord (edema, possible neuronal death)
contusion
tear in cord,permanent inj
laceration
what can laceration involve (3)
- contusion
-edema
-compression
severing of cord w/complete loss function below level of inj
transection
SCI damage (6)
- concussion
- contusion
-laceration
-transection
-hemorrhage
-blood vessel damage
what does laceration damage depend on
area of the cord
what does secondary inj result from
cellular damage to spinal cord
what does reduced blood flow to cord result in (3)
- changes in metabolic function
- destruction cell membranes
- release of free radicals
results of neurogenic shock (2)
- loss SNS influence T1 to L2 (increase in HR, constricts vessels)
- increases hypoperfusion and 2ndary inj
motor assessment for SCI
q4hrs
what can acute injury have with supression of reflexes below inj
spinal shock
delayed by spinal shock
evaluation of degree of injury
increases damage to spine
movement
total loss of sensory and motor function below level of inj
complete SCI
what is the cause of complete SCI
complete interruption of pathways
varying degree of sensory and motor function disruption bc some tracts intact
incomplete SCI
more common SCI due to greatest amt of flexibility
cervical and lumbar
Class A SCI (2)
- complete
-no motor/sensory function below level of inj
class E SCI
- normal motor and sensory functions
characteristics of central cord syndrome (3)
- preservation of outer white
- weakness/paralysis
-sensory loss > in upper Ex than lower
inj anterior portion cord, disruption blood flow through anterior spinal artery
anterior cord syndrome
injury central gray matter, preservation outer white
central cord syndrome
Se of anterior cord (3)
- paralysis
-loss of pain and temp
- preservation vibration and position sense
injury to posterior column
posterior cord syndrom
SE of post cord (3)
- no motor loss
- loss vibration and position sense
- preservation pain and temp
lateral inj to one side of cord
brown-sequard syndrome
SE of Brown seq syndrome (3)
- ipsilateral paralysis
-ipsilateral loss vibration and position sense
- contralateral loss pain and temp
ipsilateral
same side
contralateral
opposite side
have a high fall risk
posterior cord
what does CT show with incomplete SCI
bone inj and cord compression
what does MRI show with incomplete SCI (2)
soft tissue involvement
ligamentous inj when no bony abnormalily
shows changes to bone structure
xray
can cause movement and pressure on cord
damaged ligaments that move
ways to immobilize acute SCi (4)
- hard c-collar
-bedrest
- log roll
- determination of inj before change
done with high level injuries
trach
have impaired what with high level inj
diaphragmatic innervation (C2)
can cause bradycardia and hypotension
neurongenic shock
given for anti-inflam
methylprednisone
dose for methylprednisone
loading 30mg/kg IV for 15 min with NS for 45 min
then maintenance at 5.4mg/kg/hr
how long is the maintenance i loading dose is given within 3 hrs of inj
23hrs
if loading dose is given b/w 3-8 of inj how long is the maintenance
48 hrs
prophylaxis should be given for what with SCI
- GI ulcers
- blood glucose mtr d/t steroids
what does inflammation cause (2)
pressure
compromises blood supply
what is usually the result of giving methylprednisone
-insulin drip
-PPI
PPI can cause what
pneumonia d/t decreased acidity
types of traction that can be used
(3)
- gardner wells tongs
-cervical collar
- halo traction
long term complications of SCI (8)
- premature aging
- disuse syndrome
- autonomic dysreflexia
- bladder and kidney infection
- spasticity
- depression
- pressure ulcer
- heterotopic ossification hips/knees/ shoulders/elbows
bowel and bladder mgnt for SCi (2)
-stool softener
-foley for hourly I&O
pain mgnt for SCI (5)
- opiates
-muscle relaxants
- antidepressants (neuro pain)
- anticonvulsants (neuro pain)
-massage/imagery/ diversional activities
prevention for paralytic ileus
early gut feedings and ulcer prophylaxis
resp complications for SCI
pneumonia
high risk due to decreased blood flow and decreased cutaneuos response to focal presure
skin breakdown
blood pools in LE due to loss sympathetic vascular tone
ortho hypotension
tx for ortho hypo (4)
- stockings
- wraps to legs
- hydration
- gradual progression to upright position
altered thermoregulation due to what
inj above T6 level---- lack of vasoconstriction or shivering---cant sweat
DVT prophylaxis with SCI
LMWH
filter
during spinal shock total loss of motor function below injury but once resolved what occurs
spasticity
life threatening complication w/ inj at or aboveT6 that can cause Sz or stroke
autonomic dysreflexia/hyperdysreflexia
what causes AD and AH
unopposed symphathetic response below level of inj
triggers AD and AH (5)
bladder distention
constipation
infection
pressure sores
pain
SE of AD and AH (10)
-elevation in BP(life threatening)
- severe HA
- nasal congestion
-SOA
- nausea
- blurred vision
- facial flushing
- diaphoresis
- piloerection
- anxiety
tx for AD and AH (4)
- move to sitting position STAT
- identify and tx underlyin cause
- mtr BP and pulse (Presitin IV)
- mgnt of bowel and bladder function