Hematomas, cerebral swelling and cerebral edema can cause increased volume within the brain, resulting in an increase of pressure

-head elevation 30 degrees

-fluid restriction

-agitation should be minimized

-intubation and endotracheal suction should be performed carefully

-aging

-weakness in the artery wall (usually present since birth)

-hypertension 

-atherosclerosis/arteriosclerosis

retrograde amnesia

anterograde amnesia

symptoms of ppl with TBI

(12)

JA^3MIRO

judgement

attention

awareness

alertness

memory

intelligence (thinking skills)

reasoning 

orientation

(frontal and temporal lobes)

CEP^3

Concentration

EmotionPlanning

Problem Solving

Personality 

Diffuse axonal injury

concussion

contusion

coup-contrecoup injury

Second Impact Syndrome: recurrent tbi

Shaken Baby Syndrome (SBS)

seizures (> week may mean epilepsy), motor problems (swallowing problems, dysarthia), psychological problems (depression, behavioral problems), 

aphasias are rare (anomia most common symptom, discourse level and pragmatic problems)

broken bones, facial scarring (emotional reactions), emotional losses (deaths)

bruise, bleeding on the brain

when a person sustains a second tbi before the symptoms of the first have healed 

increased mm tone (hypertonia)

mm spasms

emotional lability

hallucinations

difficulty thinking and learning 

diffuse axonal injury, subdural hematomas, oxygen deprivation, swelling of the brain 

1. compound fracture

-the skull fracture is located at the ear's petrous bone

-this produces large black and blue mark looking areas below the ear, on the jaw aand the neck

-it may include snhl

-blood or csf may leak out of the ear, termed "CSF Otorrhea"

-the skull fracture is located in the anterior cranial fossa

-this produces black and blue mark looking areas around the eyes

-CSF may leak into the sinuses, termed "CSF Rhinorrhea"

-nerve damage (olfactory) for the sense of smell or eye functions may occur

no arousal or awareness of environment, eye opening, opening, or sleep/wake cycle

behavioral observation

(Glasgow Coma Scale)

minimal and inconsistent responses to environment 

individual may sporadically perform meaningful behaviors such as grasping an object or moging a body part in response to a command or environmental trigger

use behavioral observations to judge the depth and duration of impaired consciousness following injury to the brain 

-eye opening

-best motor response

-best verbal response 

Glasgow coma scale:

score 3-8

Glasgow coma scale:

9-12 

Glasgow coma scale:

13-15

Glasgow coma scale:

coma duration 

<30 min

Glasgow coma scale:

coma duration 

30 min to 1 wk

Glasgow coma scale:

coma duration 

>1 week 

problems with Glasgow coma scale'

(3)

-may not be administered at time of injury but later at the hospital

-person may have been administered drugs  that reduce cognition artifically

-motor problems may effect performance rather than cognition 

Levels of Cognitive Functioning and expected behaviors 

(Rancho Los Amigos)

based on the observation of the pt as the pt responds to the environment stimuli (does not require teh cooperation from pt)

-10 diffferent stages

-gives a common language when speaking to other professionals 

The most prevalent of these excitatory molecues are...

which occur in massive amounts following tBI, leading to over excitation and ultimately death of neurons 

the amino acids glutamate and asparate

-TBI represents an evolving dynamic process that involves multiple interrelated physicological components that exert  at the level of individual nerve cell (neuron), the level of connected networks such as neurons (neural networks), and the level of human thought (cognition)

-Beta amyloid, a protein present in neurons in Alzheimer's disease, can be deposited in neurons after TBI

-communication molecules in the brain (neurotransmitters) have either excitatory or inhibitory effects. The most prevalent of these excitatory molecules are the amino acids glutamate and asparate, which can occur in massive amounts following TBI, leading to overexcitation and ultimately death of neurons 

-At the cognitive level, alterations in neural networks and neurotransmitter systems (especially ones involving the transmitters acetylcholine, dopamine, and serotonin) can affect cognitoin and behavior

-The injured brain does have some capacity to recover. Research is underway to determine ways to promote growth of neural networks (e.g. gene therapy)

-Interventions to improve neural network and cognitive funciton may involve particular types of experience and stimulation (e.g. complex enviornments) With experience-dependent changes demonstrable in the biology of neural connections, small blood vessels, and even in the organization of brain layers

-The temporal course of recovery is probably lengthy (months to years), and the rate of recovery may vary over time.

a disorder of brain function affecting behavior and causing impared attention and cognition, motor hyperactivity and hypoactivity, altered sleep-wake cycles and latered states of arousal, ( all of these symptoms can also apply to dementia)

-delerium is acute and reversible