HO HO HO!
Thrombsgiving et al.
Traumatic Kidney Injury? WTF!
Thoughts and stuff
Just a flesh wound
100
Incidence of clinically significant HO is between __% and __%
10% and 20%
100
What is the number one presenting symptom of VTE in a TBI patient
Death
70-80%
100
Rare cause of hyponatremia in TBI patients that can be treated with clozapine
Psychogenic polydipsia - really we treat it with behavior modification and fluid restriction
100
According to Ghigo et al. endocrine evaluation of TBI should be performed at ___ and ___ times following injury
3 months and 1 year
100
Mild TBI accounts for __ to __% of TBI in the in the US.
80-90%
200
Five of the seven risk factors for HO
Prolonged coma
Immobility
Limb Spasticity or increased tone
Associated long bone fracture
Pressure ulcers
Edema
3-4 months post injury
200
Full supplemental nutrition should start within __ of injury
1 week.
200
Diabetes insipidus is caused by disruption in what hormone? Give one drug used to treat it and it's mechanism
ADH from the posterior pituitary
DDAVP - desmopressin acetate - ADH analogue without pressor activity
Chlorpropamide - potentiates ADH on RT
200
Intensive inpatient therapy for TBI shows benefit in which subgroup of TBI?
Severe TBI
200
Post concussive syndrome has __ number of symptoms for __ number of months following concussion
3 symptoms for 3 months
3 of 8 symptoms: Fatigue, sleep disturbance, headache, dizziness, irritability, affective disturbance, personality change, apathy
300
Most common sites of HO in order
Hips
Elbow
Kneews
300
What are the biggest concerns for enteral and parenteral nutrition? How do you address these?
Enteral - aspiration - advance tube, head of bed elevated during feeds
Parenteral - infection or clot (take either) - decrease time with line
300
Exam findings consistent with this help distinguish CSW and SIADH.
What is volme depletion.
CSW - volume depleted - kidneys on vacation letting everything go through
SIADH - euvolemic - kidneys working overtime to squeeze out all the water
300
Hypothalamic pituitary dysfunction has been shown to be a found in as many as __% of TBI patients
50%
300
A 30 second loss of consiousness is what grade in CANTU and Colorado?
Cantu - Grade 2 - Moderate
Colorado - Grad 3 - Severe
400
Two ways to both treat and prevent HO and one other treatment or prophylaxis
• NSAIDS - treatment, recurrence, and also prophylaxis (indomethacin as treatment)
ROM Exercises - prophylaxis and help prevent ankylosis with HO
• Control spasticity
• Bisphosphonates - Treatment only
• Radiation - THA though not really frequently used, not for TBI
• Surgery - if functional deficits after 1-1.5 years
400
What type of urinary dysfunction is seen in TBI? Give medication class and program to treat.
TBI patients are uninhibited, so the detrusor is unhibited.
Timed voids
Anticholinergic - Oxybutynin, Tolterodine, Trospium
400
Give a behavioral and medication treatment for SIADH
Fluid restriction with potentially a loop diuretic
Demeclocycline - blocks ADH action in the kidney
400
Please give 5 of 8 hormones that should be tested following TBI
AM Cortisol
IGF-I
FSH
LH
Testosterone
Estradiol
Prolactin
Urinary Free Cortisol
400
Second impact syndrome is most likely caused by ___ and carries a __ % mortality rate
Impairment in brain's vascular autoregulation
50% fatality rate
500
3 ways to detect HO and when each is most useful
Alk Phos - probably the easiest, but also the least useful (a sudden spike...maybe?)
Bone scan - 2-4 weeks after injury will see on phase I and II. Phase III in 4-8 weeks
X-rays - 3 weeks to 2 months - maturity
500
What is contrast veinography and give 3 reasons why even though it is the gold standard, its just a bad idea
Venography (also called phlebography or ascending phlebography) is a procedure in which an x-ray of the veins, a venogram, is taken after a special dye is injected into the bone marrow or veins. The dye has to be injected constantly via a catheter, making it an invasive procedure. Normally the catheter is inserted by the groin and moved to the appropriate site by navigating through the vascular system.
1) Expensive
2) Invasive
3) Contrast...alergies, reactions, kidneys
4) Contrast induced thrombosis
5) Doppler...95% sensitive
500
What happens if you treat SIADH like CSW and what happens if you treat CSW like SIADH?
If you give fluids to SIADH the Na drops.
If you fluid restrict CSW, they get more dehydrated.
500
Give 3 of four symptoms that can be treated with methylphenidate
Arousal
Attention
Processing Speed
Memory
500
Please give the 6 stages of return to play and the goal at each stage 1-5.
1) No activity - Recovery
2) Light aerobic exercise - Increase HR
3) Sport Specific Exercise - Add movement
4) Non contact training drills - Exercise coordination and cognitive load
5) Full contact practice - restore confidence and assess function
6) Return to play