TBI Causes
What percent of TBIs each year are considered mild and what is a mild TBI on GCS?
90%, 13-15
What is the most common cranial nerve effected in TBI
CN1
What neurotransmitter do Modafinil, amantadine, and methylphenidate augment?
Dopamine
The most common cause of back pain in a pediatric gymnast?
spondylolysis
What is a non-particulate steroid recommended for ESI?
dexamethasone
What is the most common cause of TBI in children?
Falls
In a TBI patient what would the treatment options be if they had a serum sodium of 165?
Central DI: Normal Saline, DDAVP, demeclocycline
Name 3 medications that function as NMDA antagonists
ketamine, methadone, amantadine
What innervates the C4-C5 facet? What innervates the L4-L5 facet?
C4, C5 medial branches, L3,L4 medial branches
What drug has a similar MOA to TCAs?
Cyclobenzaprine
What two areas of the brain are most susceptible to TBI
inferior frontal and anterior temporal
Greatest risk factor for seizure in TBI?
Penetrating trauma
You have a patient on carbamazepine. What needs to be checked regularly and why?
CBC, agranulocytosis
Discuss spondylolisthesis grading and when to operate
meyerding classification
grade 1 up to 25%, grade 2 up to 50%, grade 3 up to 75%, grade 4 up to 100%, grade 5 is >100% also called spondyloptosis
Surgery at 3 if neuro symptoms or grade 4 or 5
List 3 major side effects of opioids
respiratory depression, low testosterone (sexual dysfunction), constipation
Patient with an uncal herniation has GSC of 3, decorticate posturing on the left, right dilated pupil, what CN would be damaged and on which side?
Right CN3
You have an agitated patient on the floor. What do you do next?
Reduce stimuli
Treatment for partial seizures and treatment for complex seizures in TBI
carbamazepine, VPA
What is the criteria for diagnosis of CRPS, how do we treat CRPS, and what imaging modality may show abnormality?
Budapest criteria: sensory, vasomotor, sudomotor/edema, and motor/trophic
Contrast baths, stellate blocks
Triple Phase Bone Scan
MOA of buprenorphine
partial agonist at the mu-opioid receptor and an antagonist at the kappa-opioid receptor
What is the most common hormone dysfunction in chronic TBI?
GH deficiency
In patient with diffuse axonal injury you see white matter change in the medulla. Grade the DAI
Grade 1: nothing or present in cortex
Grade 2: corpus collosum
Grade 3: brain stem
Drug of choice for a TBI patient that develops HTN, tachycardia, and diaphoresis and why?
Propanolol. Lipophilic, crosses BBB
In DDD of the lumbar spine what percentage of weight do the facet joints bear?
70%
Which opioid receptors causes respiratory suppression?