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TNCC brain and crani
| Question | Answer |
|---|---|
| what PAD's the brain to protect it? | Pia, Arachnoid, Dura... with the pia being the inner most and the Dura being the outermost |
| Dura matter and spaces | the Dura matter is a thicker fibrous layer of the meninges and it anchors to the internal surface of the skull. it has a potential apce above and underneath it: epidural and subdural, which can be the sire of hemorhage. |
| dural spaces and vessels | there are vessels traversing theese 'spaces' the middle meningeal artery is located in the epidural apce. The bridging veins traverse the subdural space |
| why are the bridging veins more prone to hemorage in an aged brain? | brain atrophies with age, there is more space in the subdural space, more tension on the bridging veins and more susceptibilty to rupture |
| percentages of volume of intracranial contents: | brain: 80%, blood 10%, CSF: 10% |
| monro-kellie doctrine: (what it means for CBF) | as one aspect (volumes of) of ICP increases, the others must decrease in order to compensate... therefore, elevations in ICP may lead to a decrease in CBF (cerebral blood flow) and decreased perfusion |
| CPP: what is, how to work it out | CPP is the cerebral perusion pressure, basically, it is the pressure gardiuent that allows blood, 02 and nutrients to perfuse the brain. If CPP too low, or ICP too high, brain not well perfused. It is worked out by MAP-ICP |
| Intracranial pressure, whats normal? | a raised ICP is considred an ICP elevated above 15mmhg |
| whta is the normal values for CPP to maintain adequete CBF (cerebral blood flow) and cerebral perfusion | CPP less than 70mmhg will lead to ischemia. In an injured brain, CPPless than 60mmhg leads to ischemia and poor outcomes. |
| cushings response (to cerebral ischemia) | is a CNS response to poor CBF, causes an increase in systolic blood pressure, a widening pulse pressure, a reflex bradycardia and a diminished respiratory effort : all geared towards increasing arterial blood pressure to increase CBF |
| Primary and secondary brain injuries | brain injuries may be primary: ie: direct result of trauma. they may also be secondary as the result of physiological processes: eg: hypotension, oedema formation, hypoxia, hypercarbia |
| normal compensation for ICP increases | raised ICP occurs: if 1 of 3 componants of ICP expands. In compensation there may be vasoconstriction to reduce blood flow, shunting of CSFm or decreased CFS production. these measures can only last so long, or can be disrupted |
| Early and late signs of raised ICP: | early: headache, N + V, amnesia, altered LOC, restless, drowzy, chnages in speech, loss of judgement/ late: dilated nonreactive pupil, unresponsive to v or p stimuli, abnormal posturing, widening pulse pressure, >SBP, changes in resp R + P, bradyC |
| diffuse and focal brain injuries: | diffuse brain injuries dont affect a fcal point, they may affect a widespread area, rather than a focal one. examples of diffue injuires are concussion and diffuse axonal injury. examples f focal injuries include contusions and hematomas |
| consusion: | ? they think its disruption to nueronal tissue and levels of neurotransmitters: sx include: transient LOC, headache, confusion/disorientation, dizzyness, N and V, Loss of memory, difficulty concerntrating, irritability, fatigue |
| Diffuse axonal injury: what is | widespread injury, diffuse shearing tearing and compression of axons related to acceleration/decel;eration causes microscopic damage to axons: |
| Diffuse axonal injury: sx | sx: immediate unconious, (can be coma for 6 hours to months), raised ICP, abnormal posturing, hypertension, hyperthermia, excessive sweating, memory impairment, cog impirment, intelectual disability |
| cerebral contusion: | a contusion (bruise) forms in the parenchyma of the brain post forcefull injury. they can expand sx: altered LOC, bahaviour, speech, motor deficits, abnormal posturing, signs of rising ICP |
| epidural hematoma: | collection of blood in the epidural space, usually the meningeal artery due to temporal or paretial #, as is arterial blood accumulates rapidly, expanding hematmoa causes compression of underlying brain, rapid > in ICP and < in CBF and 2' brain injury. |
| epidural hematoma sx: | classic sx: transient LOC, lucid period of minutes to hours, rapid deterioration of neurological status. other sx: severe headache, sleepiness, dizziness, N and V, hemiparesis/plegia, abnormal posturing, unilateral fixed pupil |
| subdural hematoma: | focal brain injury. hematoma in subdural space. venous, from bridging veins injury. can be acute or chronic: chronic often seen in eldery or those on blood thinners due to mild head injury. |
| subdural hematoma: sx | altered LOC or steady decline in same, sx of >ICP, hemiparesis/plegia on opposite side, unilateral fixed pupil on same side .. chronic presentation is same but with slower onset of sx and with headache, ataxia, incontinance, seizures |
| list three types of skull # | linear, depressed, basilar |
| liner skull # | non-displaced # of the cranium. minor consequence unless crossing an area where arteries might be lacerated eg: temporal. sx headache, maybe <LOC |
| depressd skull # | extends below the surface of the skull and can extend to lacerate the dura and compress the underlying brain. Sx headache, <LOC, possible open #, palpable depression over # site |
| basilar skull # | # of one of the 5 basal skull bones. often accompany brain stem trauma, serious facial trauma.occular trauma, damage to intracranial structers such as brain and dura matter. |
| basilar skull # sx: | sx: headache, altered LOC, racoon eyes, battle sign, facial nerve palsy, CSG rhinorrhea/ ottorhea |
| unilateral fixed dilated puil indicates? | occular motor nerve compression caused by increased ICP/ herniation syndrome |
| bilateral fixed and pinpoint pupils may indicate: | a pintine lesion, of the effects of certain drugs, eg: opiods |
| a mildly dilated pupl with sluggish response would likely be: | an early sign of herniation syndrome |
| a widely dilated pupil can sometimes occur as a result of: | direct trauma to the globe of the eye |
| inspecting for and testing for SCF leakage | inspect rhinorreah/ottorheah. If discharge is clear/yellow and not mixed with blood, test with U/A stick for glucose, if present, its CSF. if mixed w blood (pinkish) collect sample on gauze, if a light outer ring forms round dark inner ring: contains CSF |
| severity of head injury based on GCS scores: minor, moderate, severe: | minor: gCS 13-15 / moderate: GCS 9-12 / severe: GCS <8 |
| why be extra careful when suctioning the head injury pt? | stimulation of the gag reflex causes transient rise in ICP |
| if LOC is acutely decreasing, or GCS less than 8, what intervention would you consider in the primary asessment? | early endotracheal intubation. keep the pt well oxygenated to avoid secondary brain injury |
| would you run the fluids at a rapid rate in head truma? | this depends: if the pt has signs of raised ICP, or suspected moderate to severe head injury, then you need to be careful to balance hypoperfusion, with raised ICP. |
| do you raise the head of someone you are nursing with raised ICP? | depends: may assist to reduce ICP but may also reduce CPP |
| why is it important to keep the neck and head midline in the head inury pt? | to facilitate venous drainage through the jugular veins, a turned head may compress same and impair venous drainiage |
| why might you give sedatives (anticonvulsant meds) to the severe head injury pt? | brain injury pts can have seizures, and these will increase the metabolic needs of the cerebral tissue as well as raising ICP. |
| give prophylactic anti convulsants to those head injury pts who: | have depressed skull#, had seizuers with this injury, have hx of same, penetrating brain injury, severe head injury, acute subdural hematmoa, acute epidural hematoma |
| why might you give antipyretics or cool down head injury ots? | hyperthermia increases cerebral metabolic rate and ICP. (though avoid causing shivering when cooling the pt as this too increases metabolic rate and may raise ICP) |
Created by:
jessharries