Ranch of the Friends Scale
(Ranchos Los Amigos Scale)
(Ranchos Los Amigos Scale)
non-specific, inconsistent, and non-purposeful reaction to stimuli
What is II, general response
What is propranolol?
Absences of sleep-wake cycles on EEG, eyes closed, no spontaneous purposeful movements, no language comprehension.
What is a Coma?
Vegetative State - resumption of sleep/wake cycle. opens eyes but no awareness. Startle but no tracking.
persistent VS > 1 month
permanent VS >3 months after NTBI >12 months after TBI
A patient will have incontinence, ataxia and AMS with this.
what is PTH (post-traumatic hydrocephalus)?
The loss of the ability to perform simple arithmetic calculations.
Bonus 50: Anosognosia
What is acalulia? typically resulting from disease or injury of the parietal lobe of the brain (dominant side)
Inability to recognize illness in self. Often seen with right parietal lobe lesions or large right hemispheric lesion.
Your 30 year old TBI patient is restless, violent toward staff members, and unable to state their name or place. They appear disoriented.
What is IV, confused and agitated
GABA agonist which may cause a wakening response in 5% of vegetative or minimally conscious states.
What is Zolpidem (ambiem)
Axonal Shearing from acceleration-deceleration & rotational forces.
Bonus 50: structures most damaged with this injury.
What is Diffuse axonal injury?
Bonus: Grey/white matter jxn and corpus callosum.
Clear watery drainage from one side of the nose or one ear which is worse with tilting the head and sitting upright. May be associated with a HA.
As give the TX.
What is a CSF leak. TX: lumbar drain or may resolve on its own
Preserved vertical gaze and RAS but otherwise complete paralysis.
Bonus 50: also due to what?
What is bilateral pontine lesions, Locked in syndrome
Central pontine myelinolysis due to rapid correction of hyponatremia
An 18-year-old female on your inpatient traumatic brain injury service is inconsistently oriented and does not recall your name on a day-to-day basis. She can follow single-step commands. She gets more confused when stressed but can be re-directed and can finish her therapy sessions with encouragement. She is more consistent with goal-directed behavior but needs cueing. Greater participation in activities of daily living is evident and she is developing a better awareness of self and others.
What is VI, confused and appropriate?
The CRASH trial indicated this medication is contraindicated in head injuries
What is steroids?
The classification of Post-traumatic seizures and when you use AEDs.
immediate : 1st 24hrs
Early: 1st 24hrs to 1 week (need AEDs for 1 year)
late: > 1 week (need AEDs for 2 years or greater)
no benefit beyond one week of AEDs for PPX.
Mature lamellar bone formation in extra skeletal soft tissues
Bonus: the most common place for this in TBI patients and the modality for detection
What is Heterotopic Ossification?
Bonus: Hip or knee, triple phase bone scan (2-4 weeks)
The symptoms of unilateral ACA syndrome.
What is Contralateral weakness (leg>arm) and hemiasthesia (ant limb IC) sparing face, head/eye deviation to side of lesion, urinary incontinence, pathologic grasp phenomena
You are consulted on a 58 yo gentleman after MVA and his is not oriented to self or situation. he can not give you details or his injury and upon further questioning he become angry and starts pulling at his IV lines.
You see them 2 days later and they are still not oriented but they are able to sit through your exam though they do not follow your commands. There rancho now is...
What is V confused, inappropriate.
Amantadine MOA and its use.
What is a NMDA antagonist and indirect dopamine agonist which helps to improve arousal and alertness.
The end of post-traumatic amnesia.
What is 2 successive days with a GOAT (GAlveston orientation and amnesia test) greater or equal to 75?
longer the duration of PTA the worse the outcome...
The symptoms of PAID (paroxysmal autonomic instability dystonia) and the cause.
What is agitation, hypertension, tachycardia, hyperthermia, tachypnea, spasticity, perspiration due to surge of circulating catecholamines
Millard-Gubler Syndrome
What is a Lesion in Base of the Pons (obstruction of the circumferential branches of the basilar artery causing Ipsilateral Abducens CN6 (diplopia, internal strabismus, and loss of power to rotate the affected eye outward) and facial palsy (CN7) AND Contralateral Hemiplegia, analgesia, hypoesthesia
write out the rancho los amigos scale
1: no response
2: general response
3: localized response
4: confused, agitated
5: confused, inappropriate
6: confused, appropriate
7: automatic and appropriate
8 purposeful, appropriate
A life-threatening, idiosyncratic reaction to medications that is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction
Bonus: the treatment.
What is Neuroleptic Malignant syndrome? typically due to atypicals.
Bonus: treatment with Dantrolene and BBs
A 22 year old male was involved in a motor vehicle collision. He initially required cardiopulmonary resuscitation, and was brought to the hospital's emergency department by EMS. At time of your evaluation, the patient transiently opened his eyes when you loudly voiced simple commands. He consistently verbalized words, but they were inappropriate to the situation. Part of your exam included stimulation of his arm with a sharp pin, to which he withdrew consistently. GCS =...
What is 10, moderate TBI. Opening eyes to loud voice (3), inappropriate words verbalized (3), withdrawing limb from painful stimulus (4)
eye: 4 spontaneous, 3 verbal, 2, pain, 1 none
Verbal: 5 oriented, 4 confused, 3 inappropriate, 2 incoherent, 1 none
motor 6: obeys commands, 5 localizes to pain, 4 withdraws to pain, 3 flexion/decorticate, 2 extension/decerebrate, 1 none
Risk factors for late PTS (100 pt for each up to 500pts).
What is Bilateral parietal contusions, penetrating head injury, intracranial hematoma, early PTS, depressed skull fx, prolonged coma, PTA > 24hrs
Anterior limb of internal capsule. (name of syndrome associated)
What is Clumsy hand dysarthria