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TB injury
Traumatic Brain Injury slides
Question | Answer |
---|---|
What is an acquired brain injury? | Injury to the brain that was acquired after birth i.e., tumors, strokes or trauma |
What is a traumatic brain injury? | occurs when an external force traumatically injures the brain |
What is a closed brain injury? | a type of traumatic brain injury in which the skull and dura mater remain intact |
What is an open or penetrating injury? | a head injury in which the dura mater, the outer layer of the meninges, is breached. |
Traumatic Brain injury and GCS (Mild-Severe) | 1) Traumatic Brain injury and GCS a) Mild- GCS 13-15 b) Moderate- GCS- 9-12 c) Severe GCS 4-8 |
Cerebral Blood flow during TBI | a) SABP falls- vessels dilate i) Leads to decreased cerebral profusion and ischemia b) SABP increases- vessels constrict i) Leads to vasogenic edema and increased ICP |
with TBI need to constantly monitor | LOC and do neuro checks |
What is a linear break? | Thin line break in cranial bone i) Usually OK and don’t need surgery to fix it, may have a slight concussion. ii) May need surgical intervention if CSF leakage is persistent as this indicates a dural tear and could potentiate meningitis. |
What is a Comminuted break? | Bone is splintered or crushed i) Blunt force trauma, Penetrating injuries |
What is a Basilar break? | Involve the base bones of the skull i) Raccoons eyes and Battles sign (Mastoid bruising) are indicative of this TBI |
What is an Epidural Hematoma? | i) Develops between dura and the skull due to a tear in the middle meningeal artery ii) “Talk and Die syndrome”- Lucid at first but may rapidly decline and die. iii) **Can be surgically evacuated** |
What is a Intracerebral hemorrhage? | i) Bleeding INTO the actual brain tissue (1) Commonly found in frontal or temporal lobes from a CLOSED head injury (Coup Contrecoup) |
What is a Subdural Hematoma? | i) Gathering of blood between the dura and the arachnoid mater (1) Also found commonly in CLOSED head injury. |
Nursing care for patients with TBI includes: | Neuro checks Q1/2 hrs, change can happen suddenly. HOB ~ 30 degrees to facilitate natural drainage of ICP Watch for onset of SIADH (fluid retention) or Diabetes Insipidous (Rapid fluid loss via diuresis) Fluids to manage ICP |
Do NOT use which fluids for TBI patients? | NO D5W or any HYPOtonics |
Which fluids CAN you use for TBI patients | to HYPERtonics to pull fluid into vasculature |
You should always monitor ---- to keep an eye on cerebral edema? | The patient's ICP |
Cerebral edema can result from | (a) Head trauma (b) Loss/instability of blood brain barrier (c) Na+/K+ and water regulation failure (d) Rapid reduction of serum glucose causing fluid to rush into cells. |
ICP from “normal” to OMGWTFWTFWTF?! | Normal: 0-15 mmHg Mild elevation: 16-20 mmH Moderate: 21-30 mmHg Severe: 31-40 Very severe: 41+ |
Monro-Kellie hypothesis | the brain an only accommodate so much tissue, CSF and blood all of which contribute to ICP there is a “CRITICAL VOLUME” (may vary from patient to patient) at which the brain will begin to shunt blood, CSF or more fatally, brain tissue. |
Management of Cerebral profusion pressure (CPP) | CPP is a measurement of profusion to the brain and is calculated by subtracting the ICP from the MAP (CPP= MAP-ICP) THUS an increase in ICP leads to a DECREASE in CPP. This should make sense because the increased pressure is impeding blood flow to the br |
Diagnostic findings | CT, MRI, Lumbar puncture, Lab:Test for serum osmolarity and hydration status (1) 282-295 NORMAL (2) 315+ Mannitol doesn’t work anymore ii) ABG’s to look specifically at electrolytes, glucose AND CO2 as it affects the brain more and is a strong vasodil |
What happens with Brain Herniation? | 7) Brain Herniation a) Prolonged increased ICP predisposes brain to this potentially life threatening change. b) ALL WILL PRESENT WITH A DECREASE IN LEVEL OF CONSCIOUNESS*** |
Supratentorial Herniation consists of : | Cingulate herniation- lateral shift, not life threatening Central- downward shift of 1 or both hemispheres Uncal- MOST COMMON, usually temporal shift Transclavicular- Protrusion of brain through skull. frequently occurs after a SKULL trauma or PENETRAT |
Infratentorial Herniation consists of: | i) Downward cerebellar (1) Downward shift through foramen magnum ii) Upward transtentorial (1) Upward shift compressing CN3 and distorting 3rd ventricle. |