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47 Cards in this Set
- Front
- Back
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MECHANISM OF INJURY FOR TBI
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PENETRATING + BLUNT [DECELERATION, ACCELERATION, ROTATIONAL]
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PATHOPHYSIOLOGY: PRIMARY INJURY OF TBI
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OCCURS AT MOMENT OF IMPACT; MAY BE LOCALIZED TO ONE AREA OR DIFFUSE
E.G. CONTUSION, LACERATION, SHEARING INJURIES |
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PATHOPHYSIOLOGY:SECONDARY INJURY OF TBI
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- BIOCHEMICAL AND CELLULAR RESPONSE TO INITIAL TRAUMA
- MAY CAUSE LOSS OF BRAIN TISSUE THAT WAS NOT ORIGINALLY DAMAGED |
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CAUSES OF 2ARY INJURY OF TBI
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H4IC
HYPOTN, HYPOXEMIA, HYPERCAPNIA, ISCHEMIA, CEREBRAL EDEMA |
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S/S OF HYPOTN/HYPOXIA OF TBI
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CI3D
CELL SWELLING; INCREASE ICP, INCREASE BLOOD VOLUME, INCREASE VASODILATOR, DECREASE CEREBRAL PERFUSION |
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CLASSES OF INJURIES OF TBI
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1. SKULL FX
2. CONCUSSION 3. CONTUSION 4. HEMATOMA 5. DAI (COMA) |
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S/S SKULL FX OF TBI
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C2RABP
CSF OTORRHEA OR RHINORRHEA, CT FOR DX, RACOON EYES, BATTLE'S SIGN, PALSY OF CN VII |
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BRAIN INJURY WITH BRIEF LOSS OF CONSCIOUSNESS
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CONCUSSSION
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S/S OF CONCUSSION OF TBI
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CONFUSION, N/V, H/A, DISORIENT
*LAST SECONDS TO HOUR WITH BRAIN STILL INTACT |
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BRUISING OF THE BRAIN
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CONTUSION
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CONTUSION IS MOST COMMON IN WHAT?
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FRONTAL AND TEMPORAL LOBES (MAJOR RISK FOR HERNIATION)
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CONTUSION CAN OCCUR COUP
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TISSUE AFFECTED DIRECTLY UNDER IMPACT
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CONTUSION CAN OCCUR COUTRACOUP
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TISSUE AFFECTED IN A LINE DIRECTLY OPPOSITE OF THE POINT OF IMPACT
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CONTUSION ALMOST ALWAYS ASSOCIATED WITH
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SDH
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CONTUSION DX
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CT SCAN
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CONTUSION BP?
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ITITIALLY HTN THEN HYPOTN = PROB
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S/S OF BRAINSTEM HERNIATION IN CONTUSION OF TBI
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WIDE PULSE PRESSURE (SYSTOLIC UP, DIASTOLIC DOWN), TEMP UP, UNEQUAL PUPIL, CUSHING TRIAD
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EXTRAVASATION OF BLOOD L/T INCREASE ICP
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HEMATOMA
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3 TYPES OF HEMATOMA (TBI)
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1. EPIDURAL
2. SUBDURAL 3. INTRACEREBRAL |
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BETWEEN THE SKULL AND OUTMOST LAYER OF DURA
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EPIDURAL HEMATOMA
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EPIDRUAL HEMATOMA USUALLY CAUSED BY
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DIRECT TRAUMA
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S/S OF EPIDRUAL HEMATOMA OF TBI
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L3
BRIEF LOC, LUCIDITY BRIEF, RAPID DETERIO IN LOC |
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HALLMARK SIGN OF EPIDURAL HEMATOMA
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IPSILATERAL DILATED AND FIXED PUPIL
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ACCUMULATION OF BLOOD BETWEEN DURA AND ARACHONOID MEMBRANE
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SUBDURAL HEMATOMA
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SUBDURAL HEMATOMA CAUSEED BY..
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RUPTURE OF VEIN B/W C.CORTEX AND DURA
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3 TYPES OF SUBDURAL HEMATOMA
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ACUTE, SUBACUTE, CHRONIC
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ACUTE SUBDURAL HEMATOMA
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AFTER TRAUMA; DECEREBORATE/DECORTIRATE POSTURE
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SUBACUTE SUBDURAL HEMATOMA
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2 DAYS - 2 WK; DECERE/DECORT POSTURE
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CHRONIC SUBDURAL HEMATOMA
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DAY TO MONTHS AFTER TRAUMA; AT RISK ARE ELDERLY, ANTICOAGULANT THERAPY, COORDINATION/BALANCE PROB
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CHRONIC SUBDURAL HEMATOMA S/S
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LETHARGY, ABSENT MIND, H/A, VOMITING, STIFF NECK, PHOTOPHOBIA, PUPILLARY CHANGE, TIA, SEIZURE, HEMIPARESIS
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BLEEDING W/IN BRAIN TISSUE
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INTRACEREBRAL HEMATOMA
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CAUSES OF INTRACEREBRAL HEMATOMA
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DEPRESSED SKULL FX, PENETRATING INJURIES, SUDDEN ACCELERATION/DECELERATION INJURIES
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MAJOR RISK FOR MISSSLE INJURY
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INFECTION
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PROLONG POSTTRAUMATIC COMA NOT CAUSED BY MASS LESION
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DIFFUSE AXONAL INJURY
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MILD DAI...
MOD DAI... SEVERE DAI... |
MILD DAI...<24H
MOD DAI...>24H SEVERE DAI...PROLONG WITH HTN, HYPERTHERMIA, HYPERSWEAT |
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ASSESSMENT OF TBI
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- NEURO MOST IMPORTANT****
- GCS [15=BEST, 3=LOWEST; < OR = 7 = COMA; EYE, MOTOR, VERBAL] - PUPILLARY REACTION - MOTOR STRENGTH |
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DEGREE OF TBI: MILD
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GCS 13-15
LOC UP TO 15 MIN USUALLY D/C WITH FAMILY |
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DEGREE OF TBI: MODERATE
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GCS 9-12
LOC UP TO 6H HIGH RISK FOR DETERIORATE |
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DEGREE OF TBI: SEVERE
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GCS 8 OR <
ICU OFTEN VENTILATED HEMODYNAMIC MONITOR SERIAL CT SCAN TO FIND CAUSER |
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MED MANAGEMENT OF TBI
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SURGERY, MANAGE ICP + CPP, OXYGENATION, TX COMPLICATIONS
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ASSESSMENT OF TBI
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ABC, NEURO [PERRLA, LOC, RESP FUNCTION, VS, SERIAL ASSESS]
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CTR: CT SCAN FOR TBI
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FLAT + STRESS = INCREASE ICP
GO WITH 'EM |
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SEDATION = DECREASE NEURO
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D/C SEDATION X15 MIN TO ASSESS
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NURSING MANAGEMENT OF TBI
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VS, ICP, CPP, PREVEN FURTHER DAMAGE, ADMINISTER MANNITOL, TITRATE FLUIDS + PRESSORS, TX OF COMLICATIONS
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NURSING DX OF TBI
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DECREASE INTRACRANIAL ADAPTIVE CAPCITY
INEFFECTIVE CEREBRAL TISSUE PERFUSION IMPAIRED GAS EXCHANGE INEFFECTIVE BREATHING PATTERN RISK FOR ASPIRATION IMPAIRED PHYSICAL MOBILITY POWERLESSNESS |
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CTR FOR SUCTIONING FOR TBI
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SUCTION 2X ONLY, <10 SECONDS, HYPEROXYGENATE B4 AND AFTER, MINIMIZE AIRWAY STIMULATION
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CTR FOR MANNITOL ADMNISTRATION FOR TBI
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OSMOTIC DIURECTICS; 1-2G/KG IV; WARM + SHAKE; COOL = CRYSTALLIZE; FILTER NEEDLE;
CHECK SERUM OSMOLALITY ***CALL DR IF S.OSMOLALITY >310 |
