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TB injury

Traumatic Brain Injury slides

QuestionAnswer
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.
Created by: UARN85