308 slide TBI TRAUMATIC BRAIN INJURY Treatment PowerPoint Presentation on CD For Sale
When you click on links to various merchants on this site and make a purchase, this can result in this site earning a commission. Affiliate programs and affiliations include, but are not limited to, the eBay Partner Network.
308 slide TBI TRAUMATIC BRAIN INJURY Treatment PowerPoint Presentation on CD :
$11.99
Thank you!
If you do not wish to have your item(s) delivered on data disc(s), I can provide them on a flash drive and other means as well. Just let me know if a disc does not work for you and we can discuss delivery by other methods.
COMBINING SHIPPING COSTS
Are you purchasing multiple items? I will: a) combine all invoices before payment and charge shipping equivalent to one item, or b) refund all shipping costs in excess of one item after payment.
All derivative (i.e. change in media; by compilation) work from this underlying U.S. Government public domain/public release data is COPYRIGHT © GOVPUBS
$3.00 first class shipping in U.S.
Includes the Adobe Acrobat Reader for reading and printing publications.
Numerous illustrations and matrices.
Contains the following key public domain (not copyrighted) U.S. Government publication(s) on one CD-ROM in both Microsoft PowerPoint and Adobe Acrobat PDF file formats:
TITLE: Traumatic Brain Injury, 308 pages (slides)
Partial SLIDE TOPICS, SUBTOPICS and CONTENTS:TBI 1
Joseph Kamerath
PMR PGY2
TBI 1
In An Instant
Joseph Kamerath
PMR PGY2
TBI 1
Mild/Mod/Severe
Combat TBI
Anatomy
Pathophysiology
Imaging
Next time… Management, treatment etc
(TBI 2: In Several Instances)
TBI
Toronto Bay Initiative – A non-profit, volunteer-based charitable community organization dedicated to a cleaner, greener, healthier, and more accessible Toronto Bay
Total Body Irradiation – When radiation is delivered in a manner that it covers the whole body
Tolerate Bill’s Ignorance – He doesn’t know any better
TBI
National Brain Injury Association
TBI is an insult to the brain, not of a congenital or degenerative nature that may produce a diminished or altered state of consciousness which results in impairment of cognitive abilities or physical functioning. It can also result in the disturbance of cognitive abilities or physical functioning. These impairments may be either temporary or permanent and cause partial or total functional disability or psychosocial impairment.
TBI
Center for Disease Control
Any occurrence of injury to the head that is documented in a medical record, with one of the following conditions attributed to head injury:
Observed or self-reported decreased level of consciousness
Amnesia
Skull fracture
Objective neurological or neuropsychological abnormality
Prevention
airbags
safety belts
motorcycle helmets
motorcycle proficiency
bicycle helmets
violence prevention programs
falls prevention programs for the elderly
following the rules of play in a sport
use of proper sport equipment
Prevention Programs such as “Think First”
Mild TBI
Traumatic head injury with ANY of the following:
LOC: < 30 min
If >30 min; init GCS of 13-15
PTA: < 24 H
AMS: At time of accident
Focal Neuro deficits: Transient or prolonged
No abnormalities on CT scan
No operative lesions
Length of hospital stay < 48 hours
Mild TBI
Nausea
Vomiting
Dizziness
Headache
Blurred vision
Sleep disturbances
Quick fatigue
Lethargy
Some other nondescript sensory loss
Mild TBI: Cognitive Deficits
Decreased:
Attention
Concentration
Perception
Memory
Speech/language abilities
Executive functioning
Mild TBI: Behavioral Changes
Poor emotional responsivity
Emotional lability
Irritability
Quick to anger
Disinhibition
Moderate TBI
Inpt >= 48 hours
GCS score of 9-12 or higher
Operative intracranial lesion
Abnormal CT scan findings
Severe TBI
Occurs with prolonged unconscious state or coma.
Coma no response
Vegetative state sleep-wake cycle/arousal
no interaction
Persistent vegetative state for > one month
Minimally responsive state awareness of environment
prim reflexes, inconsistent
Akinetic mutism dopamine pathway damage
minimal mvmt, eye tracking
Locked in syndrome only eyes move, able to think
Brain Death
Combat TBI
Combat TBI
Blast Injury (1°, 2°, 3°)
Combat TBI
Blast Injury (1°, 2°, 3°)
Polytrauma
Combat TBI
Blast Injury (1°, 2°, 3°)
Polytrauma
Infections
Combat TBI
Blast Injury (1°, 2°, 3°)
Polytrauma
Infections
PTSD
Combat TBI
Blast Injury (1°, 2°, 3°)
Polytrauma
Infections
PTSD
Hippocampus
Prefrontal cortex
amygdala
Primary Injury
Focal
Occur at a specific location in brain
Cerebral Contusion
Intracranial Hemorrhage
Epidural hematoma
Subdural hematoma
Intracerebral Hemorrhage
Subarachnoid Hemorrhage
Diffuse
Diffuse Axonal Injury
Primary Injury
Open/Closed
Cerebral Contusions
Cortical bruising; crests of gyri
Into depths if injury is forceful enough
Gray matter abnormality
Frontal and temporal lobes most effected
Commonly b/l, not nec. symmetrical
Low velocity injury (falls)-usually
Contusion
Frontal
Temporal
Concussion
Deformity of the deep structures of the brain
Widespread neurologic dysfunction
Impaired consciousness or coma
Mild DAI?
Epidural Hematoma
Subdural Hematoma
Subarachnoid Hematoma
Intracerebral hematoma
Intraventricular hemorrhage
Brain herniation:
Supratentorial herniation
Subfalcine herniation:
Most common
Central transtentorial herniation
Uncal herniation
Cerebellar herniation
Diffuse Axonal Injury
Centripetal Model
Disruption at node of Ranvier
Excitotoxicity
Most Vulnerable:
cerebral hemispheres, corpus collosum, midbrain, pons
Diffuse Axonal Injury
Excitatory amino acids:
Glutamate
Aspartate
Glycine
Secondary Brain Injury
Intracranial hemorrhage
Subdural or epidural hematomas
Herniation
Hydrocephalus
Cerebral edema
Cerebral ischemia
Conditions that exacerbate 2º injury:
Hypoxemia
Hypercarbia
Hypotension
Acidosis
Cerebral edema: Causes
Neurochemical transmitters
Increased ICP
Disruption of the blood brain barrier
Impairment of vasomotor autoregulation
Dilatation of cerebral blood vessels
Progression of injury
Cranial insult
Tissue edema
Increasing ICP
Compression of arteries
Decreased cerebral blood flow
Decreased O2 with cellular death
Edema around necrotic tissue
Progression
Increasing ICP with compression of brainstem and respiratory center
Accumulation of CO2 resulting in vasodilation
Increasing blood volume further increasing ICP
Death
Cerebral Physiology
AutoRegulation
CVR maintain CPP despite MAP
Responsive to pCO2
CBF=CPP/CVR
CPP=MAP-ICP
MAP= 2DP+SBP/3
NL= 50-150
Hypotension
Most prognostic factor
Episode of decreased BP correlated with poor outcome
MAP> 90
CPP= MAP- ICP
Most important to keep CPP > 70
Hydration, Pressors
Future Physiology…
Biomarkers
S100B
Neuron-specific enolase
Myelin basic protein
Glial fibrillary acid protein
Frontal Lobe
Paralysis
Sequencing
Perseveration
Attending
Lability
Social behavior
Personality
Problem solving
Expressive (Broca's) aphasia
Parietal Lobe
Inability to attend to more than one object at a time.
Anomia
Agraphia
Alexia
Left/Right confusion
Dyscalculia
Apraxia
Inability to focus visual attention
Hand-eye coordination
Occipital Lobe
Visual field cuts
Difficulty with locating objects in environment
Difficulty in recognizing drawn objects
Color Agnosia
Hallucinations
Visual illusions
Movement Agnosia
Temporal Lobes
Prosopagnosia (faces)
Wernicke's aphasia
Short/long term memory
Decreased interest in sex
Inability to catagorize objects (Categorization).
Right lobe damage can cause
persistent talking
Aggression
Brain Stem
Decreased respiratory vital capacity (speech)
Dysphagia
Balance/movement
Vertigo
Insomnia, sleep apnea
Endocrine abnormalities
Cerebellum
Coordination/balance
Inability to reach out and grab objects.
Tremor
Vertigo
Slurred Speech (Scanning Speech).
Rapid movements
Imaging
CT
Imaging
CT
MRI
Imaging
CT
MRI
D-MRI (Diffusion MRI)
Diffusion Weighted Imaging
Imaging
CT
MRI
D-MRI
DTI (Diffusion Tension Imaging)
Diffusion Tensor Imaging (DTI)
Imaging
CT
MRI
D-MRI
DTI
BOLD fMRI (Blood Oxygen Level Dependant)
BOLD fMRI
Imaging
CT
MRI
D-MRI
DTI
BOLD fMRI
PW-MRI (Perfusion Weighted)
Imaging
CT
MRI
D-MRI
DTI
BOLD fMRI
PW-MRI
MRS (Magnetic Resonance Spectroscopy)
Imaging
CT
MRI
D-MRI
DTI
BOLD fMRI
PW-MRI
MRS
SWI (Susceptibility-Weighted Imaging)
SWI
Imaging
CT
MRI
D-MRI
DTI
BOLD fMRI
PW-MRI
MRS
SWI
PET
PET
TBI 2
Joseph Kamerath
PGY2
TBI Complications/Mgmt etc…
TBI Rehab State of Science 2006
Pharmcologic neuroprotection
Nonpharmacologic acute treatment
Seizure
HO
DVT
Spasticity
Dysautonomia
Hydrocephalus
Cognitive Rehab
Pharm tx of cognitive deficits
TBI Complications/Mgmt etc…
Posttraumatic agitation
Cranial Neuropathy
Endocrine
Headache
Depression
Pharmacologic Neuroprotection
Corticosteroids: bad
Pharmacologic Neuroprotection
Corticosteroids: bad
NMDA receptor antagonists?
Gacyclidine: maybe
Pharmacologic Neuroprotection
Corticosteroids bad
NMDA receptor antagonists?
Cannabiniod
Dexabinol: no benefit
Pharmacologic Neuroprotection
Corticosteroids bad
NMDA receptor antagonists?
Cannabiniod
Dexabinol
Magnesium, Progesterone, Cyclosporine, Citicoline effective in preclinical models
NIH trials now underway
Nonpharm acute tx
Hypertonic saline
Nonpharm acute tx
Hypertonic saline
Nutrition
Nonpharm acute tx
Hypertonic saline
Nutrition
Therapeutic hypothermia
Nonpharm acute tx
Hypertonic saline
Nutrition
Therapeutic hypothermia
Early decompressive craniectomy
Posttraumatic Seizures
Immediate – within 1 day post injury
Early – within 1-7 days
Late – after 1st week
Proposed mechanism of PTS
Posttraumatic Seizures
Most occur within 1-3 months
50-66% within 1 yr
75-80% within 2 yr
Mild TBI – 1.5%
Mod TBI – 2.9%
Severe TBI – 17%
Overall – 3.1%
Risk Factors for late PTS
Penetrating head injury (33-50%)
Intracranial hematoma (25-30%)
Early Sz (25%)
Depressed skull fracture (3-70%)
Prolonged coma/PTA >24hrs (35%)
Others – Dural tearing, Presence of FB, Age, ETOH, TCAs, focal signs (aphasia/hemiplegia)
Prophylactic Anticonvulsants
Valproic acid, carbamazepine less sedating
All anticonvulsants - Sedating, cognitive deficits
Duration of treatment.
Phenytoin – Effective at preventing early PTS (Temkin ’90)
No proof of improved outcome
Withdrawal of anticonvulsants
Related Items:
Original Slide: SMS Railroad Company Baldwin S-12 308
$3.50
308 slide TBI TRAUMATIC BRAIN INJURY Treatment PowerPoint Presentation on CD
$11.99
1325 PHOTO GLASS SLIDE PLANE/SHIP Military PBY CATALINA USN PATROL 1947 308
$5.88