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47 Cards in this Set

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MECHANISM OF INJURY FOR TBI
PENETRATING + BLUNT [DECELERATION, ACCELERATION, ROTATIONAL]
PATHOPHYSIOLOGY: PRIMARY INJURY OF TBI
OCCURS AT MOMENT OF IMPACT; MAY BE LOCALIZED TO ONE AREA OR DIFFUSE

E.G. CONTUSION, LACERATION, SHEARING INJURIES
PATHOPHYSIOLOGY:SECONDARY INJURY OF TBI
- BIOCHEMICAL AND CELLULAR RESPONSE TO INITIAL TRAUMA
- MAY CAUSE LOSS OF BRAIN TISSUE THAT WAS NOT ORIGINALLY DAMAGED
CAUSES OF 2ARY INJURY OF TBI
H4IC

HYPOTN, HYPOXEMIA, HYPERCAPNIA, ISCHEMIA, CEREBRAL EDEMA
S/S OF HYPOTN/HYPOXIA OF TBI
CI3D

CELL SWELLING; INCREASE ICP, INCREASE BLOOD VOLUME, INCREASE VASODILATOR, DECREASE CEREBRAL PERFUSION
CLASSES OF INJURIES OF TBI
1. SKULL FX
2. CONCUSSION
3. CONTUSION
4. HEMATOMA
5. DAI (COMA)
S/S SKULL FX OF TBI
C2RABP

CSF OTORRHEA OR RHINORRHEA, CT FOR DX, RACOON EYES, BATTLE'S SIGN, PALSY OF CN VII
BRAIN INJURY WITH BRIEF LOSS OF CONSCIOUSNESS
CONCUSSSION
S/S OF CONCUSSION OF TBI
CONFUSION, N/V, H/A, DISORIENT

*LAST SECONDS TO HOUR WITH BRAIN STILL INTACT
BRUISING OF THE BRAIN
CONTUSION
CONTUSION IS MOST COMMON IN WHAT?
FRONTAL AND TEMPORAL LOBES (MAJOR RISK FOR HERNIATION)
CONTUSION CAN OCCUR COUP
TISSUE AFFECTED DIRECTLY UNDER IMPACT
CONTUSION CAN OCCUR COUTRACOUP
TISSUE AFFECTED IN A LINE DIRECTLY OPPOSITE OF THE POINT OF IMPACT
CONTUSION ALMOST ALWAYS ASSOCIATED WITH
SDH
CONTUSION DX
CT SCAN
CONTUSION BP?
ITITIALLY HTN THEN HYPOTN = PROB
S/S OF BRAINSTEM HERNIATION IN CONTUSION OF TBI
WIDE PULSE PRESSURE (SYSTOLIC UP, DIASTOLIC DOWN), TEMP UP, UNEQUAL PUPIL, CUSHING TRIAD
EXTRAVASATION OF BLOOD L/T INCREASE ICP
HEMATOMA
3 TYPES OF HEMATOMA (TBI)
1. EPIDURAL
2. SUBDURAL
3. INTRACEREBRAL
BETWEEN THE SKULL AND OUTMOST LAYER OF DURA
EPIDURAL HEMATOMA
EPIDRUAL HEMATOMA USUALLY CAUSED BY
DIRECT TRAUMA
S/S OF EPIDRUAL HEMATOMA OF TBI
L3

BRIEF LOC, LUCIDITY BRIEF, RAPID DETERIO IN LOC
HALLMARK SIGN OF EPIDURAL HEMATOMA
IPSILATERAL DILATED AND FIXED PUPIL
ACCUMULATION OF BLOOD BETWEEN DURA AND ARACHONOID MEMBRANE
SUBDURAL HEMATOMA
SUBDURAL HEMATOMA CAUSEED BY..
RUPTURE OF VEIN B/W C.CORTEX AND DURA
3 TYPES OF SUBDURAL HEMATOMA
ACUTE, SUBACUTE, CHRONIC
ACUTE SUBDURAL HEMATOMA
AFTER TRAUMA; DECEREBORATE/DECORTIRATE POSTURE
SUBACUTE SUBDURAL HEMATOMA
2 DAYS - 2 WK; DECERE/DECORT POSTURE
CHRONIC SUBDURAL HEMATOMA
DAY TO MONTHS AFTER TRAUMA; AT RISK ARE ELDERLY, ANTICOAGULANT THERAPY, COORDINATION/BALANCE PROB
CHRONIC SUBDURAL HEMATOMA S/S
LETHARGY, ABSENT MIND, H/A, VOMITING, STIFF NECK, PHOTOPHOBIA, PUPILLARY CHANGE, TIA, SEIZURE, HEMIPARESIS
BLEEDING W/IN BRAIN TISSUE
INTRACEREBRAL HEMATOMA
CAUSES OF INTRACEREBRAL HEMATOMA
DEPRESSED SKULL FX, PENETRATING INJURIES, SUDDEN ACCELERATION/DECELERATION INJURIES
MAJOR RISK FOR MISSSLE INJURY
INFECTION
PROLONG POSTTRAUMATIC COMA NOT CAUSED BY MASS LESION
DIFFUSE AXONAL INJURY
MILD DAI...
MOD DAI...
SEVERE DAI...
MILD DAI...<24H
MOD DAI...>24H
SEVERE DAI...PROLONG WITH HTN, HYPERTHERMIA, HYPERSWEAT
ASSESSMENT OF TBI
- NEURO MOST IMPORTANT****
- GCS [15=BEST, 3=LOWEST; < OR = 7 = COMA; EYE, MOTOR, VERBAL]
- PUPILLARY REACTION
- MOTOR STRENGTH
DEGREE OF TBI: MILD
GCS 13-15
LOC UP TO 15 MIN
USUALLY D/C WITH FAMILY
DEGREE OF TBI: MODERATE
GCS 9-12
LOC UP TO 6H
HIGH RISK FOR DETERIORATE
DEGREE OF TBI: SEVERE
GCS 8 OR <
ICU
OFTEN VENTILATED
HEMODYNAMIC MONITOR
SERIAL CT SCAN TO FIND CAUSER
MED MANAGEMENT OF TBI
SURGERY, MANAGE ICP + CPP, OXYGENATION, TX COMPLICATIONS
ASSESSMENT OF TBI
ABC, NEURO [PERRLA, LOC, RESP FUNCTION, VS, SERIAL ASSESS]
CTR: CT SCAN FOR TBI
FLAT + STRESS = INCREASE ICP

GO WITH 'EM
SEDATION = DECREASE NEURO
D/C SEDATION X15 MIN TO ASSESS
NURSING MANAGEMENT OF TBI
VS, ICP, CPP, PREVEN FURTHER DAMAGE, ADMINISTER MANNITOL, TITRATE FLUIDS + PRESSORS, TX OF COMLICATIONS
NURSING DX OF TBI
DECREASE INTRACRANIAL ADAPTIVE CAPCITY

INEFFECTIVE CEREBRAL TISSUE PERFUSION

IMPAIRED GAS EXCHANGE

INEFFECTIVE BREATHING PATTERN

RISK FOR ASPIRATION

IMPAIRED PHYSICAL MOBILITY

POWERLESSNESS
CTR FOR SUCTIONING FOR TBI
SUCTION 2X ONLY, <10 SECONDS, HYPEROXYGENATE B4 AND AFTER, MINIMIZE AIRWAY STIMULATION
CTR FOR MANNITOL ADMNISTRATION FOR TBI
OSMOTIC DIURECTICS; 1-2G/KG IV; WARM + SHAKE; COOL = CRYSTALLIZE; FILTER NEEDLE;
CHECK SERUM OSMOLALITY

***CALL DR IF S.OSMOLALITY >310