Exam 15: Head Injuries
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| Craniocerebral Trauma | Include an alternation in consciousness.
Second most common cause of neurological injury.
Head trauma is used to signify craniocerebral trauma or head injury which includes an alteration of consciousness, no matter how brief.
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| Craniocerebral Trauma (Fun Facts) | Major cause of death between ages 1 and 35.
TBI incidence twice as high in males than females.
The amount of obvious damage may not reflect the extent of injury.
Effects of injury can lead to cerebral edema, IICP and sensory and/or motor deficits.
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| Craniocerebral Trauma (Causes) | MVA’s
Falls
Recreational injuries
Sports trauma
Assaults
Craniocerebral Trauma
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| Craniocerebral Trauma Results in injury to | Scalp
Skull
Brain tissue
Injuries vary
Scalp lacerations
Open fractures
Severe brain damage
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| Injuries to the brain can result from | direct or indirect trauma
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| Indirect trauma | the tension strain and shearing forces transmitted by the stretching of the neck.
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| Direct trauma | when the head is directly injured. This results in an acceleration-deceleration injury with rotation of the skull and its contents. Bruising of the occipital and frontal lobes as well as the brain stem and cerebellum may occur.
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| Craniocerebral Trauma Effects include | Cerebral edema
Sensory deficits
Motor deficits
Increased intracranial pressure
Open Head Injuries
Linear
Comminuted
Depressed
Compound fractures
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| Linear Fracture | incomplete break, typical line
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| Depressed Fracture | Results from a blunt trauma to a flat bone- causing an indentation
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| Comminuted Fracture | Bone is shattered into two or more fragments or pieces
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| Compound fracture | an open wound exists over the fracture site, often bone may be protruding through the skin
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| Closed Head Injuries | Laceration
Concussion
Contusion
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| Laceration | Bleed profusely
Is not always relevant to the significance of the injury.
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| lacerations of the scalp bleed profusely because | large vascularity in the region. Heavy bleeding is not always reflective of significant injury.
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| Concussion | results from violent jarring of the brain against the skull. Patient can experience brief loss of consciousness followed by confusion, headache, irritability, dizzy spells, unsteady gait.
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| Contusion | Damage to brain tissue and nerve fibers
Bruising and possible hemorrhage
Bruising at site of injury or on opposite side
Permanent damage may result
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| Contusion is more severe than a concussion due to | possible hematoma, bruising and possible hemorrhage of superficial cerebral tissue. Bruising of the brain occurs at site of injury or on the opposite side. Permanent damage may result
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| Contusion results from a | serious blow to the head associated with damage to brain tissue and nerve fibers
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| Hematoma | Results from hemorrhage post-craniocerebral trauma
Require careful and continuous observation
Common sites
Epidural
Subdural
Intracerebral
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| place patients at higher risk for hematoma | Anticoagulants such as Heparin, Lovenox, ASA, Coumadin as well as bleeding disorders such as Thrombocytopenia, Aplastic Anemia, Hemophilia, Leukemia
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| Epidural Hematoma | Arterial bleeding between the dura and skull
Initial unconsciousness-regains consciousness then lapses into coma
Headache
Ipsilateral pupil changes
Contralateral hemiparesis
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| Epidural hematoma should be considered | if lethargy and unconsciousness develop after the pt regains consciousness
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| Ipsilateral pupil | pupil changes on the same side as injury
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| Contralateral hemiparesis | muscle weakness on the opposite site of the hematoma
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| Subdural Hematoma | Venous bleeding between the dura & subarachnoid layers
Acute, subacute or chronic bleed
Progressive ↓ in LOC
Ipsilateral pupil changes
↓ extraoccular muscle movement
Periodic episodes of memory lapse, confusion, drowsiness, and personality changes
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| Suspect subdural hematoma | if a patient who has been conscious for several days after an injury has decreased LOC or develops any of the above neurologic signs.
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| craniocerebral trauma: S&S | Signs of ↑ICP
Decreased or altered LOC
One of the earliest signs
May develop rapidly or slowly
HA
Vomiting (possibly projectile)
Changes in VS
Signs and Symptoms
Nausea
Abnormal sensation
Bleeding/fluid from nose (rhinorrhea) or ears (otorrhe
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| Basilar Skull Fracture Signs | . Battle’s sign – periauricular ecchymosis - bruising near/of the mastoid process behind the ear.
Raccoon eyes – periorbital ecchymosis – bruised area around the eyes.
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| Cushing’s Triad or Cushing’s Response | An important diagnostic sign of late-stage IICP Increased Systolic Blood Pressure.Widening Pulse Pressure (difference between systolic and diastolic measurement) .Bradycardia
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| Dx tests for craniocerebral trauma | Detecting CSF in otorrhea and rhinorrhea drainage
Dextrostick
Halo sign
Tes-tape
CT Scan
MRI
PET Scan
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| Halo sign | Collect droplets on white absorbent pad. Creates a yellow ring that encircles a central red area - indicative of leakage of CSF.
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| The Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) assist in diagnosing | Skull fractures and/or embedded skull fragment. Intracranial bleeding. Shifts in brain tissue. Edema at the injury site. Densities that indicate presence/location of hematoma.
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| A positron emission tomography, or PET, scan | an imaging technique that uses positively charged particles (radioactive positrons) to detect subtle changes in the body's metabolism and chemical activities. A PET scan provides a color-coded image of the body's function, rather than its structure.
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| intraventricular catheter | burr hole is drilled through the skull. The catheter is inserted through the brain into the lateral ventricle.
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| Epidural Sensor | inserted between the skull and dural tissue. Less evasive., but cannot remove excess CSF.
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| Subarachnoid bolt | hollow screw in the skull whose tip projects through the dura into the subarachnoid space
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| Craniocerebral Trauma Medications Administered | Reduce cerebral edema & IICP
Osmotic diuretics (Mannitol)
Corticosteroids (Dexamethasone)
Anticonvulsants
Dilantin
Cerebyx
Non opioid analgesics
Antipyretics
Pegorgotein
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| Mannitol- Osmotic diuretic | for IICP, draw water from the edematous brain tissue.
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| Dexamethasone Corticosteroids | for IICP- anti-inflammatory, must monitor blood sugar levels because the medication can affect carbohydrate metabolism and glucose utilization.
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| Anticonvulsants | to treat or reduce seizures: Phenytoin (Dilantin). Fosphenytoin (Cerebyx)
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