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46 Cards in this Set
- Front
- Back
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Why does scalp laceration result in profuse bleeding
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Scalp is very vascular
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When might scalp laceration require surgery
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Avulsion, otherwise sutured at bedside
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how can you assess for skull Fx in scalp laceration
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palpate lightly
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palpate after scalp lac and feels firm i.e. no Fx. You...
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Apply pressure.
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palpate after scalp lac and feels soft i.e. Fx. You...
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Just cover, no pressure
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Main complication of scalp lac
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Potential for blood loss
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Skull Fx carries potential for what type of hematoma
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epidural
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Intracranial process that might result in CSF drainage from nose/ears
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Basilar skull fracture
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Drainage from nose/ears indicates _____ tear.
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Dural
-Basilar Fx |
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What nursing action do you take when you see ottorhea/rhinorrhea
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Allow to drain freely
-don't pack -don't suction |
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battles sign and racoons eyes assoc with...
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Basilar skull Fx
-Late Sx's |
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Why must you avoid NG/nasotrach insertion in basilar Fx
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Dural tear may provide direct entry to brain
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Why might basilar Fx pt show signs of meningeal irritation
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meninges irritation secodnary to dural tear
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Alteration inmental status that may/may not involve loss of consciousness
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Concussion
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Post concussion syndrome may last up to ?? year following event
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1 year
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How are brain contusions Tx'd
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Agressive Tx if IICP
-Bruising assoc with hemorrhage and edema |
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Craniotomy indic
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Hemorrhage/bleed
Hematoma/Contusion Aneurysm (coil/clip) Placement of IVD |
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Seizure prphylaxis s/p craniotomy
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Dilantin
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Bleed between skull and dura amter
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Epidural hematoma
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-Brief unconsciousness after initial insult
-Followed by lucid interval -Followed by rapid deterioration in neuro status from confusion>coma>death |
Epidural hematome
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Big complication of epidrual hematoma
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Herniation
-Posturing -Cushings -Unilateral dilation |
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Tx of epidural hematoma
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Immediate Neurosurgical Surgery
-Neuro 911-resp arrest may occur within minutes -Craniotomy |
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Bleeding between dura mater and arachnoid covering the brain
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Subdural hematoma
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Associated with tearing of veins in head
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Subdural hematoma
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hematome assoc with elderly and alcoholics
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Subdural hematome
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Type of subdural hematoma requiring immediate intevention
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Acute subdural hematoma
-neuro changes over 24-48 hours -may progress to herniation |
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HOB remains flat with this type of hematoma
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Subdural
-prevents tension on veins thereby decreasing rebleed |
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How may a CT differentiate a chronic subdural hematoma from other subtypes
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Layering of blood or thickened fibrous membrane
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Type of subdural hematoma often seen in elderly with Hx of falling
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Chronic subdural
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Subarachnoid hematoma complications
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Intracerebral bleed
Subdural hematoma Hydrocephalus IICP |
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% of pt's with S&S prior to subarachnoid bleed
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50%
-Localized HA -Lethargy -Neck pain -Noise in head -Pain behind/above eye -Occulomotor changes |
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S&S of subarachnoid hematoma after bleeding has occured
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Classic Sx=worst HA of life
-Decreased LOC -hemiparesis, hemiplegia or posturing -Sx of meningeal irritation |
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Worst HA of my life assoc with
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Sub arachnoid hematoma
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Causes of subarachnoid hematoma
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Main=aneurysm
Long term coumadin tehrapy also |
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Aneurysm precautions consist of
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Low stim environment
-no visitors -dim light -quiet |
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Why might SAH pt be on analgesia/sedation
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Excruciating HA
-Usually NSAID as you don't want to mask neuro Sx's |
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Endovasc technique
Clip of coil |
Coil
-Clipping is craniotomy |
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Craniotomy/clipping shown to have good outcomes when performed __ from ruprture
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24-48 hours
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Biggest comlication of SAH
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Vasospasm
Occurs in 70-90% Others include -rebleed -hydrocephalus |
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S&S of vasopspasm
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Mimic that of anuerysm
Typically only produce Sx's in 30% of pt's All late Sx's -HA -Altered LOC -Speech impairment -Hemiparesis -Seizures |
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Vasospasm implications
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Reduces cerebreal bf distally>May cause either brain ischemia or infarct
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Rx used prophylactically post SAH to alleve abnormal contraction of vascular smooth muscle
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CCB
Nimodipine |
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Nimodipine assoc with
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Used in SAH prophylactically to reduce vspospasm potential
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Triple H therapy assoc with
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SAH/vasospasm
-Used as the vasospasm occurs |
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Components of Triple H
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Hypervolemia
Hemodilution Induced hypertension |
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Best precaution against re-bleed post SAH
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Early clip/coil
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