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45 Cards in this Set
- Front
- Back
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What is a head injury?
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broad classification that includes injury to the scalp, skull or brain
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Define primary brain injury?
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initial damage to the brain that results from the traumatic event
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Define secondary brain injury?
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after effects of injury: edema, ischemia, chemical changes
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Why is ICP so bad?
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causes restriction of blood flow to the brain, dec O2 delivery and waste removal---ischemia, infarction, brain damage (brain may herniate)
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Why do scalp injuries bleed so badly, what is life threatening, and what should one worry about?
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the blood vessels in the scalp constrict poorly
avulsion (tearing away) is a true emergency and life threatening intracranial infection is always a concern |
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Define simple, comminuted, depressed or basilar skull fractures?
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Simple- linear break in the bone
Comminuted- multiple fracture line Depressed- bone fragments embedded into brain tissue Basilar- fracture at base of skull |
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Symptoms of local head injuries depend on what?
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severity, distribution of injury
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What is the main sign of a head injury?
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localized persistant pain
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What do fractures of the base of the skull (basilar) cause?
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hemorrage from the nose, pharynx, ears, conjuctiva
CSF from ears and nose Blood and CSF from wound- halo sign Ecchymosis (bruising) behind the ears- Battle's sign |
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Diagnosis and treatment of head injury?
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X-ray, CT scan, MRI, cerebral angiography
observation, surgery, head elevation, no blowing nose, debridement |
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Define brain injury?
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injury to the brain that is severe enough to interfer with normal functioning
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What is a closed (blunt) brain injury?
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brain accelerates then decelerated or collides with another object -- no opening in skull
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What is an open brain injury?
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object pentrates the skill, enters the brain and damages the soft brain tissue
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What are the s/s of traumatic brain injury?
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altered LOC, confusion, pupillary abn, altered gag reflex, sudden neurological deficits, change in VS, vision/hearing impairments, headache, SZ
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What is a cerebral concussion?
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temporary loss of neurological fx with no apparent structural damage
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What are the s/s of a concusion?
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dizziness, seeing stars, loss of consciouness, bizarre behavior (frontal lobe) or amnesia (temperol lobe)
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What is postconcussion syndrome?
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headache, dizziness, lethargy, irritability, anxiety
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What signs indicate notification of the MD?
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difficulty waking, speaking, confusion, severe headache, vomiting, weakness on one side of the body
arouse pt often |
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Describe a brain contusion?
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brain is bruised, unconsious for more then a few seconds, motionless, faint pulse, shallow resp, BP and temp abn, recovery depends on amot of damage and edema
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Describe axonal injury?
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widespread axon damage, immediate coma, posturing, cerebral edema
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what are the most serious brain injuries?
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Hematomas that develop within the cranial vault
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describe an epidural hematoma?
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momentary loss of consciousness, rapid absorption of CSF followed by compression and rapid deteriation of patient. burr holes, craniotomy and drains may be needed
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What are common causes of subdural hematomas?
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trauma, coagulopathies, or rupture of aneurysm
more often venous in origin |
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Describe an acute subdural hematomas?
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dev over 24-48 hr, changes in LOC, pup signs, hemiparesis, coma, inc bp, dec HR, slowing resp
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Describe subacute subdural hematomas?
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less severe, 48 hours to 2 weeks, changes in LOC, pup signs, hemiparesis, coma, inc bp, dec HR, slowing resp
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Describe chronic subdural hematoma?
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3 weeks to months, occurs in elderly, intracranial compression occurs, blood clots from bleed calcify, headache, personality change, mental deterioration
requires surgical evacution of clot |
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What is an intracerebral hemorrage or hematoma?
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bleeding into the substance of the brain from a small force exerted on the head
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what issues do you consider when managing a brain injury?
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presume c-spine injury until proven otherwise, watch for edema, ICP, hypotension, hypovolemia (bleeding), fluid and electrolytes, resp dysfx (O2), BP, SZ prevention, agitation (bencodiazepines), NG tube b/c head injury may cause red gastric mobility, regurgitation and aspiration
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What are the three signs of brain death? How do you confirm this?
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coma, absence of brain-stem reflexes, apnea
EEG and cerebral blood flow |
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Assessing a brain injury patient
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health history, baseline, LOC-Glasgow Coma Scale, freq neuro assess, multisystem assessm
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What are potential complications of a brain injury?
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dec cerebral perfusion, cerebral edema and herniation, impaired ventilation and oxygenation, impaired F/E/ nutritional balance, risk of post traumatic sz
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Goals for brain injury?
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patent airway, CPP, F/E/nutrition bal, prevention of seconday injury, body temp, skin integrity, cognitive fx, adeq sleep, family coping, knowledge of rehab
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What do you want to continually do for this patient?
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ongoing neuro assessm (glasgow), VS
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What are the signs of increasing ICP?
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bradycardia, increasing systolic BP, widening pulse pressure
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What are the signs of brain compression?
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increased resp, decrease BP, decrease pulse
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What other signs are bad for a brain injury?
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increase temp (increase metabolic demands), tachycardia and hypotension indicate bleeding
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What can you do to help maintain a PT airway?
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HOB at 30°, proper suctioning, monitor ABGs, and pulmonary complications, guard against aspiration and resp insuff
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What electrolyte imbalance is common after a head injury?
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hyponatremia, due to shift of ECF, electrolytes and vol
urine tests, I/O, daily weight |
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When should a NG or NJ tube be placed in?
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within the first 48 hours
increase in protein and nutritional needs |
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To prevent injury to the person what should you do?
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assess O2, bladder, dressing constrictions, use padded side rails, mittens, reduce environmental stimuli, provide skin care, normal sleep cycles, infection prevention, good lighting, avoid opioids for agitation
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What might cause body temp changes and what should be done?
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damage to hypothalamus, cerebral irritation, infection
ID cause, acetaminophen, cooling blankets (do not induce shivering---increases ICP) |
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What is adequate CPP?
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greater than 70 mm Hg
lower can cause hypoxia, ischemia |
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What are ways to control ICP?
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elevate HOB, keep head and neck in neutral position, maintain normal body temp, admin O2 to maintain PaO2 >90, maintain fluid balance, avoid noxious stimuli, CPP >70
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ICP from edema and swelling will peak how long after injury>
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2-3 days
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A posttraumatic SZ is classified late if it occurs how long after the injury?
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more than 7 days
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