Polytrauma and Traumatic Brain Injury

Total Page：16

File Type：pdf, Size：1020Kb

POLYTRAUMA AND TRAUMATIC BRAIN INJURY The U.S. Department of Veterans Affairs (VA) provides medical and rehabilitation services to Veterans and Service members with traumatic brain injury (TBI). VA’s Polytrauma/TBI System of Care is a nationwide network of over 110 facilities. Specialized rehabilitation programs and services are coordinated across four tiers of care to provide the right expertise at the right time and location. WHAT IS TRAUMATIC BRAIN INJURY (TBI)? TBI may happen from a blow to the head, or an object penetrating the brain. Falls and vehicular accidents are the most common causes of TBI. TBI can occur during combat, training and civilian activities. Care for TBI occurs in both inpatient and outpatient settings. Interdisciplinary teams collaborate with Veterans and families to address individualized goals throughout the continuum of recovery across the veteran’s lifespan. TBI SYMPTOMS TBI SCREENING TBI OUTCOMES • Mild TBI may result in • VA screens all post-9/11 • VA tracks TBI rehabilitation headaches, dizziness, and Veterans with a history of outcomes for Veterans treated changes in sleep, behavior and military deployment for in the five VA Polytrauma cognition. Symptoms resolve possible TBI on their initial Rehabilitation Centers within weeks to months in entry into VA health care. and compares these with most individuals. Common • Veterans with positive TBI outcomes for patients treated co-occurring conditions may screen are referred to specialty in the private sector through prolong recovery for some. providers for comprehensive collaborative research with the • In cases of moderate to severe evaluation and to develop a Traumatic Brain Injury Model TBI / Polytrauma, symptoms plan of care, as necessary. Systems. can be life-threatening and • Case Managers are assigned to • VA outcomes compare result in chronic health assist Veterans by coordinating favorably to those from problems and long-term services and resources to the civilian TBIMS in the functional disability. optimize rehabilitation percentages of patients outcomes. discharged to home and those living independently years following rehabilitation. For more information at: www.polytrauma.va.gov Last Updated: November 2020.

Copy Link

Recommended publications

Spinal Cord Injury and Traumatic Brain Injury Research Grant Program Report 2020
This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp Spinal Cord Injury and Traumatic Brain Injury Research Grant Program Report January 15, 2020 Author About the Minnesota Office of Higher Education Alaina DeSalvo The Minnesota Office of Higher Education is a Competitive Grants Administrator cabinet-level state agency providing students with Tel: 651-259-3988 financial aid programs and information to help [email protected] them gain access to postsecondary education. The agency also serves as the state’s clearinghouse for data, research and analysis on postsecondary enrollment, financial aid, finance and trends. The Minnesota State Grant Program is the largest financial aid program administered by the Office of Higher Education, awarding up to $207 million in need-based grants to Minnesota residents attending eligible colleges, universities and career schools in Minnesota. The agency oversees other state scholarship programs, tuition reciprocity programs, a student loan program, Minnesota’s 529 College Savings Plan, licensing and early college awareness programs for youth. Minnesota Office of Higher Education 1450 Energy Park Drive, Suite 350 Saint Paul, MN 55108-5227 Tel: 651.642.0567 or 800.657.3866 TTY Relay: 800.627.3529 Fax: 651.642.0675 Email: [email protected] Table of Contents Introduction 1 Spinal Cord Injury and Traumatic Brain Injury Advisory Council 1 FY 2020 Proposal Solicitation Schedule
[Show full text]
Traumatic Brain Injury
REPORT TO CONGRESS Traumatic Brain Injury In the United States: Epidemiology and Rehabilitation Submitted by the Centers for Disease Control and Prevention National Center for Injury Prevention and Control Division of Unintentional Injury Prevention The Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation is a publication of the Centers for Disease Control and Prevention (CDC), in collaboration with the National Institutes of Health (NIH). Centers for Disease Control and Prevention National Center for Injury Prevention and Control Thomas R. Frieden, MD, MPH Director, Centers for Disease Control and Prevention Debra Houry, MD, MPH Director, National Center for Injury Prevention and Control Grant Baldwin, PhD, MPH Director, Division of Unintentional Injury Prevention The inclusion of individuals, programs, or organizations in this report does not constitute endorsement by the Federal government of the United States or the Department of Health and Human Services (DHHS). Suggested Citation: Centers for Disease Control and Prevention. (2015). Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Atlanta, GA. Executive Summary . 1 Introduction. 2 Classification . 2 Public Health Impact . 2 TBI Health Effects . 3 Effectiveness of TBI Outcome Measures . 3 Contents Factors Influencing Outcomes . 4 Effectiveness of TBI Rehabilitation . 4 Cognitive Rehabilitation . 5 Physical Rehabilitation . 5 Recommendations . 6 Conclusion . 9 Background . 11 Introduction . 12 Purpose . 12 Method . 13 Section I: Epidemiology and Consequences of TBI in the United States . 15 Definition of TBI . 15 Characteristics of TBI . 16 Injury Severity Classification of TBI . 17 Health and Other Effects of TBI .
[Show full text]
NIH Public Access Author Manuscript J Neuropathol Exp Neurol
NIH Public Access Author Manuscript J Neuropathol Exp Neurol. Author manuscript; available in PMC 2010 September 24. NIH-PA Author ManuscriptPublished NIH-PA Author Manuscript in final edited NIH-PA Author Manuscript form as: J Neuropathol Exp Neurol. 2009 July ; 68(7): 709±735. doi:10.1097/NEN.0b013e3181a9d503. Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury Ann C. McKee, MD1,2,3,4, Robert C. Cantu, MD3,5,6,7, Christopher J. Nowinski, AB3,5, E. Tessa Hedley-Whyte, MD8, Brandon E. Gavett, PhD1, Andrew E. Budson, MD1,4, Veronica E. Santini, MD1, Hyo-Soon Lee, MD1, Caroline A. Kubilus1,3, and Robert A. Stern, PhD1,3 1 Department of Neurology, Boston University School of Medicine, Boston, Massachusetts 2 Department of Pathology, Boston University School of Medicine, Boston, Massachusetts 3 Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, Massachusetts 4 Geriatric Research Education Clinical Center, Bedford Veterans Administration Medical Center, Bedford, Massachusetts 5 Sports Legacy Institute, Waltham, MA 6 Department of Neurosurgery, Boston University School of Medicine, Boston, Massachusetts 7 Department of Neurosurgery, Emerson Hospital, Concord, MA 8 CS Kubik Laboratory for Neuropathology, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Abstract Since the 1920s, it has been known that the repetitive brain trauma associated with boxing may produce a progressive neurological deterioration, originally termed “dementia pugilistica” and more recently, chronic traumatic encephalopathy (CTE). We review the 47 cases of neuropathologically verified CTE recorded in the literature and document the detailed findings of CTE in 3 professional athletes: one football player and 2 boxers.
[Show full text]
Traumatic Brain Injury(Tbi)
TRAUMATIC BRAIN INJURY(TBI) B.K NANDA, LECTURER(PHYSIOTHERAPY) S. K. HALDAR, SR. OCCUPATIONAL THERAPIST CUM JR. LECTURER What is Traumatic Brain injury? Traumatic brain injury is defined as damage to the brain resulting from external mechanical force, such as rapid acceleration or deceleration impact, blast waves, or penetration by a projectile, leading to temporary or permanent impairment of brain function. Traumatic brain injury (TBI) has a dramatic impact on the health of the nation: it accounts for 15–20% of deaths in people aged 5–35 yr old, and is responsible for 1% of all adult deaths. TBI is a major cause of death and disability worldwide, especially in children and young adults. Males sustain traumatic brain injuries more frequently than do females. Approximately 1.4 million people in the UK suffer a head injury every year, resulting in nearly 150 000 hospital admissions per year. Of these, approximately 3500 patients require admission to ICU. The overall mortality in severe TBI, defined as a post-resuscitation Glasgow Coma Score (GCS) ≤8, is 23%. In addition to the high mortality, approximately 60% of survivors have significant ongoing deficits including cognitive competency, major activity, and leisure and recreation. This has a severe financial, emotional, and social impact on survivors left with lifelong disability and on their families. It is well established that the major determinant of outcome from TBI is the severity of the primary injury, which is irreversible. However, secondary injury, primarily cerebral ischaemia, occurring in the post-injury phase, may be due to intracranial hypertension, systemic hypotension, hypoxia, hyperpyrexia, hypocapnia and hypoglycaemia, all of which have been shown to independently worsen survival after TBI.
[Show full text]
Mild Traumatic Brain Injury and Concussion: Information for Adults
Mild Traumatic Brain Injury and Concussion: Information for Adults Discharge Instructions You were seen today for a mild traumatic brain injury (mild TBI) or concussion. Watch for Danger Signs Use this handout to help you watch In rare cases, a dangerous blood clot that for changes in how you are feeling crowds the brain against the skull can develop or acting and to help you feel better. after a TBI. The people checking on you should call 911 or take you to an emergency Be sure to let a family member or department right away if you have: friend know about your injury and the types of symptoms to look out • A headache that gets worse and does not for. They may notice symptoms go away before you do and can help you. • Significant nausea or repeated vomiting • Unusual behavior, increased confusion, Schedule a follow-up appointment restlessness, or agitation with your regular doctor. • Drowsiness or inability to wake up Due to your injury, you may need to take some • Slurred speech, weakness, numbness, or time off from things like work or school. If so, ask decreased coordination your doctor for written instructions about when • Convulsions or seizures (shaking or you can safely return to work, school, sports, twitching) or other activities such as driving a car, riding a • Loss of consciousness (passing out) bike, or operating heavy equipment. More information on mild TBI and concussion, as well as tips to help you feel better, can be found at www.cdc.gov/TraumaticBrainInjury. Learn About Your Injury Mild TBI and concussions are brain injuries.
[Show full text]
Guidelines for BLS/ALS Medical Providers Current As of March 2019
Tactical Emergency Casualty Care (TECC) Guidelines for BLS/ALS Medical Providers Current as of March 2019 DIRECT THREAT CARE (DTC) / HOT ZONE Guidelines: 1. Mitigate any immediate threat and move to a safer position (e.g. initiate fire attack, coordinated ventilation, move to safe haven, evacuate from an impending structural collapse, etc). Recognize that threats are dynamic and may be ongoing, requiring continuous threat assessments. 2. Direct the injured first responder to stay engaged in the operation if able and appropriate. 3. Move patient to a safer position: a. Instruct the alert, capable patient to move to a safer position and apply self-aid. b. If the patient is responsive but is injured to the point that he/she cannot move, a rescue plan should be devised. c. If a patient is unresponsive, weigh the risks and benefits of an immediate rescue attempt in terms of manpower and likelihood of success. Remote medical assessment techniques should be considered to identify patients who are dead or have non-survivable wounds. 4. Stop life threatening external hemorrhage if present and reasonable depending on the immediate threat, severity of the bleeding and the evacuation distance to safety. Consider moving to safety prior to application of the tourniquet if the situation warrants. a. Apply direct pressure to wound, or direct capable patient to apply direct pressure to own wound and/or own effective tourniquet. b. Tourniquet application: i. Apply the tourniquet as high on the limb as possible, including over the clothing if present. ii. Tighten until cessation of bleeding and move to safety.
[Show full text]
CDC Concussion Definition and Pathophysiology
Concussion Definition and Pathophysiology The Evolving Definition of Concussion CDC Physicians Toolkit; Collins, Gioia et al 2006 Regarding Cerebral Concussion…… A concussion (or mild traumatic brain injury) is a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the head. Disturbance of brain function is related to neurometabolic dysfunction, rather than structural brain injury, and is typically associated with normal structural imaging findings (CT Scan, MRI). Concussion may or may not involve a loss of consciousness. Concussion results in a constellation of physical, cognitive, emotional, and sleep‐related symptoms. Recovery is a sequential process and symptoms may last from several minutes to days, weeks, months, or even longer in some cases.” . Following a concussion, there are metabolic chemical changes that take place in the brain. Brain injury can occur even if there is NO loss of consciousness. More than 90% of concussions DO NOT involve loss of consciousness. Memories of events BEFORE and AFTER the concussion are MORE accurate assessments of SEVERITY than loss of consciousness. Pathophysiology of Concussions – Dr. Micky Collins, Director UPMC Sports Medicine Concussion Program Neurometabolic Cascade of Concussion During activities a concussion can occur with any type of external force to the head. These events can cause the brain to accelerate and decelerate with translational, rotational and/or angular forces. Brain injuries can result on the side of the force, cu, or the opposite side of the force, contra cu. So what exactly do these forces do to the brain? Researchers believe it leads to a wave of energy that passes through the brain tissue triggering neuronal dysfunction.
[Show full text]
Traumatic Brain Injury (TBI)
Traumatic Brain Injury (TBI) Carol A. Waldmann, MD raumatic brain injury (TBI), caused either by blunt force or acceleration/ deceleration forces, is common in the general population. Homeless persons Tare at particularly high risk of head trauma and adverse outcomes to TBI. Even mild traumatic brain injury can lead to persistent symptoms including cognitive, physical, and behavioral problems. It is important to understand brain injury in the homeless population so that appropriate referrals to specialists and supportive services can be made. Understanding the symptoms and syndromes caused by brain injury sheds light on some of the difficult behavior observed in some homeless persons. This understanding can help clinicians facilitate and guide the care of these individuals. Prevalence and Distribution recover fully, but up to 15% of patients diagnosed TBI and Mood Every year in the USA, approximately 1.5 with MTBI by a physician experience persistent Swings. million people sustain traumatic brain injury disabling problems. Up to 75% of brain injuries This man suffered (TBI), 230,000 people are hospitalized due to TBI are classified as MTBI. These injuries cost the US a gunshot wound and survive, over 50,000 people die from TBI, and almost $17 billion per year. The groups most at risk to the head and many subsequent more than 1 million people are treated in emergency for TBI are those aged 15-24 years and those aged traumatic brain rooms for TBI. In persons under the age of 45 years, 65 years and older. Men are twice as likely to sustain injuries while TBI is the leading cause of death.
[Show full text]
Head to Toe Critical Care Assessment for the Trauma Patient
Head to Toe Assessment for the Trauma Patient St. Joseph Medical Center – Tacoma General Hospital – Trauma Trust Objectives 1. Learn Focused Trauma Assessment 2. Learn Frequently Seen Trauma Injuries 3. Appropriate Nursing Care for Trauma Patients St. Joseph Medical Center – Tacoma General Hospital – Trauma Trust Prior to Arrival • Ensure staff have received available details of the case • Notify the entire responding Trauma team • Assign tasks as appropriate for Trauma resuscitation • Gather, check and prepare equipment • Prepare Trauma room • Don PPE (personal protective equipment) • MIVT way to obtain history: Mechanism of injury Injuries sustained Vital signs Treatment given Trauma Trust St. Joseph Medical Center – Tacoma General Hospital – Trauma Trust Primary Survey • Begins immediately on patient’s arrival • Collection of information of injury event and past medical history depend on severity of condition • Conducted in Emergency Room simultaneously with resuscitation • Focuses on detecting life threatening injuries • Assessment of ABC’s Trauma Trust St. Joseph Medical Center – Tacoma General Hospital – Trauma Trust Primary Survey Components Airway with simultaneous c-spine protection and Alertness Breathing and ventilation Circulation and Control of hemorrhage Disability – Neurological: Glasgow Coma Scale [GCS] or Alert, Voice, Pain, Unresponsive [AVPU] Exposure and Environmental Controls Full set of vital signs and Family presence Get resuscitation adjuncts (labs, monitoring, naso/oro gastric tube, oxygenation and pain)
[Show full text]
Traumatic Brain Injury in the UNITED STATES Emergency Department Visits, Hospitalizations and Deaths 2002–2006
Traumatic Brain Injury IN THE UNITED STATES Emergency Department Visits, Hospitalizations and Deaths 2002–2006 U.S. Department of Health and Human Services Centers for Disease Control and Prevention www.cdc.gov/TraumaticBrainInjury Traumatic Brain Injury IN THE UNITED STATES Emergency Department Visits, Hospitalizations and Deaths 2002–2006 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Injury Prevention and Control www.cdc.gov/TraumaticBrainInjury MARCH ZXYX AuthoRs Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006 is a publication of the National Center for Injury Prevention and Mark Faul, PhD, MS Control, Centers for Disease Control and Prevention. National Center for Injury Prevention and Control Division of Injury Response Centers for Disease Control and Prevention Thomas R. Frieden, MD, MPH, Director Likang Xu, MD, MS National Center for Injury Prevention and Control National Center for Injury Prevention and Control Robin Ikeda, MD, MPA, Acting Director Division of Injury Response Division of Injury Response Marlena M. Wald, MPH, MLS Richard C. Hunt, MD, FACEP, Director National Center for Injury Prevention and Control The ﬁndings and conclusions in this report are those of the Division of Injury Response authors and do not necessarily represent the ofﬁcial position of the Centers for Disease Control and Prevention (CDC). Victor G. Coronado, MD, MPH National Center for Injury Prevention and Control Division of Injury Response suggesteD CItAtIoN: Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006.
[Show full text]
Spinal Cord Injury and Traumatic Brain Injury Research Grant Program Report January 15, 2019
Spinal Cord Injury and Traumatic Brain Injury Research Grant Program Report January 15, 2019 Author About the Minnesota Office of Higher Education Alaina DeSalvo The Minnesota Office of Higher Education is a Competitive Grants Administrator cabinet-level state agency providing students with Tel: 651-259-3988 financial aid programs and information to help [email protected] them gain access to postsecondary education. The agency also serves as the state’s clearinghouse for data, research and analysis on postsecondary enrollment, financial aid, finance and trends. The Minnesota State Grant Program is the largest financial aid program administered by the Office of Higher Education, awarding more than $198 million in need-based grants to Minnesota residents attending accredited institutions in Minnesota. The agency oversees tuition reciprocity programs, a student loan program, Minnesota’s 529 College Savings Plan, licensing and early college awareness programs for youth. Minnesota Office of Higher Education 1450 Energy Park Drive, Suite 350 Saint Paul, MN 55108-5227 Tel: 651.642.0567 or 800.657.3866 TTY Relay: 800.627.3529 Fax: 651.642.0675 Email: [email protected] Contents Introduction 6 Spinal Cord Injury and Traumatic Brain Injury Advisory Council 7 Table 1. Advisory Council Roster 7 FY 2019 Proposal Solicitation Schedule and Proposals Received 8 Fiscal Year 2019 Annual Research Grant Proposal Solicitation Schedule 8 Fiscal Year 2019 Spinal Cord Injury and Traumatic Brain Injury Research Grant Proposals Received 8 Grant Selection
[Show full text]
Delayed Intracranial Hemorrhage After Mild Traumatic Brain Injury in Patients on Oral Anticoagulants: Is the Juice Worth the Squeeze?
European Review for Medical and Pharmacological Sciences 2021; 25: 3066-3073 Delayed intracranial hemorrhage after mild traumatic brain injury in patients on oral anticoagulants: is the juice worth the squeeze? M. COVINO1,2, A. MANNO1, G.M. DELLA PEPA3, A. PICCIONI1, G. TULLO1, M. PETRUCCI1, S. NAVARRA1, F. SARDEO1, E. TORELLI1, R. NICOLÒ1, B. SIMEONI1, L. CARBONE1, S. GAUDINO2,4, F. FRANCESCHI1,2 1Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy 2Università Cattolica del Sacro Cuore, Rome, Italy 3Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy 4Department of Neuroradiology, Institute of Radiology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy Abstract. – OBJECTIVE: Mild Traumatic a routine control CT scan seems advisable only Brain Injury (MTBI) in anticoagulated patients is for patients presenting a clinical deterioration. a common challenge for Emergency Department Larger, prospective trials are required to clari- (ED) Physicians. Anticoagulation is considered fy the safety profile of DOACs vs. VKA in MTBI. a risk factor for developing delayed intracranial hemorrhage (ICH) after MTBI. The occurrence of Key Words: this event in patients on Vitamin K Antagonists Mild traumatic brain injury, Anticoagulation, Direct (VKA) or Direct Oral Anticoagulants (DOACs) re- oral anticoagulants, Intracranial hemorrhage. mains unclear. Primary endpoint: to analyze the role of anticoagulants as risk factors for devel- oping delayed ICH after MTBI and evaluate the Introduction indications to repeat a cranial computed tomog- raphy (CT) after a period of observation. Sec- Traumatic brain injury (TBI) represents one ondary endpoint: to assess the difference in the prevalence rate of delayed ICH in patients on of the most common causes of morbidity and VKA versus those on DOACs.
[Show full text]