Acute TBI Management
These are (at least) 3 things that can be done to lower ICP
What are..
1. Elevate HOB 30-45 degrees
2. Hyperventilation (temporary)
3. Hypertonic Solutions/diuretics
4. Hypothermia- falling out of favor, worse outcomes
The MCC of TBI in elderly vs Pediatrics
What are falls vs MVC?
Best treatment for TBI related agitation
What is- let them burn off the energy?
The Glasgow Outcome Scale has this many levels...
What is 5?
1 = dead
2 = vegetative state
3 = conscious but dependent
4 = independent but disabled
5 = independent
This many electrodes must be on patient during NCS
What is 3?
Red- Re"d"ference
Black- BlActive
Green- Ground
This type of posturing is concerning, because it may signal to injury below Red Nucleus
What is decerebrate posturing?
Legs extended, arms extended
The 3 Primary Injury Mechanisms in TBI
What is shear forces, Contusions, DAI
What is the PRIMARY reason antipsychotics are C/I in TBI
What is slow motor recovery?
PTA ends with a score of __ on the O-log (Orientation log)
What is 25 days?
Need 2 straight days, technically over on 1st day
Ideal place for ground electrode
What is between Cathode and Active electrode?
This is CPP (equation)
What is CPP=MAP-ICP?
Mild TBI AKA concussion is currently defined as.. (3 things)
What is GCS 13-15, LOC<30 min, PTA <1 day
Can have AMS/focal neuro deficits without the above
3 classes meds of that are first line for agitation
What is B2 blockers, SSRIs, Mood stabilizers?
PTA ends with a score of __ on the GOAT (Galveston Orientation Amnesia Test)
75
Need 2 straight days but PTA ended on first day
These two findings are suggestive of acute denervation on needle EMG
What is fibs/sharps and decreased recruitment?
Target CPP and ICP respectively
What is <20mmHg and >60mmHg
Damage in one area causing damage in a remote are that was connected to that area Recovery in area 2 parallels recovery of area 1
What is Diaschisis?
The MOA of the most studied medication for wakefulness in TBI
What is Dopamine potentiation?
Amantadine
DAI grade 2 means...
Involving deep white matter (Corpus Callosum)
1 = lobar white changes
2 = central white matter changes
3 = brainstem involvement
This finding will be observed on needle EMG of a patient w/ steroid myopathy
What is normal study?
Remember EMG only tests type 1 and steroids affect type 2
This type of imaging is best to assess for DAI (be specific)
What is Diffusion-weighted MRI?
Diffusion- DAI
The agitation behavior scale <__ is normal and >__ is severe
What is 21 and 34?
This medication for wakefulness/DOC does NOT lower seizure threshold
What is Methylphenidate?
Both modafinil and Amantadine can lower seizure threshold
Ranchos 1 is no response, 2 is generalized, 3 is localized
Ranchos scores 4-8 are..
4. Confused Agitated (4 on the floor)
5. Confused Inappropriate
6. Confused Appropriate
7. Automatic Appropriate
8. Purposeful Appropriate
Normal recruitment ratio
What is 5?
First motor unit 5->10 w/ 2nd at 5-> 15 w/ second at 10 and 3rd at 5