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Head Injury

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Question
Answer
What are the different type of injuries?   scalp lacerations, skull fractures, minor head trauma and major head trauma  
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Why are scalp lacerations of concern?   The scalp is very vascular and a lot of bleeding can occur and can also become infected  
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What are the different types of skull fractures?   linear/depressed, simple, comminunted, complex, open or closed  
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What complications can arise from a skull fracture?   hematoma, intracranial infection and meningeal and brain tissue damage  
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What does an open skull fracture entail?   Requires an ID, and possible dural closure if CFS is leaking  
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What are the clinical manifestations of a skull fracture?   facial paralysis, Battle's sign, periorbital eccymosis (raccoon eyes), conjugated deviation of the gaze, rhinorrhea, ottorrhea (+ CFS gives dura tear), +VE for glucose  
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What is Battle's sign?   mastoid eccymosis (bruising behind the ear)  
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What is a minor diffuse injury and what are the S/S?   concussion, decreased LOC, retrograde amnesia, and HA  
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How long does post-concussion syndrome last?   2 weeks to 2 months  
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What are the S/S of post-concussion syndrome?   persistent HA, lethargy, sometimes dizziness, personality and behavioral changes, short attention span and short term memory loss  
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What is another name for a major head trauma?   Traumatic Brain Injury (TBI)  
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Which types are TBIs?   contusions and lacerations  
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What is coup and contre-coup?   coup is the blow at the direct impact on the skull and contre-coup is secondary area of damage on the opposite side (against the blow)  
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What is a contusion?   a mass movement of the brain inside the skull  
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What are the effects of a contusion?   minimal bleeding around the site, focal changes, decreased LOC and seizures  
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What are the S/S of a laceration?   hemorrhage, hematoma, seizures, cerebral edema  
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What are S/S of an intracranial hemorrhage?   unconsciousnesses, hemiplegia on contralateral side, dilated pupil on ipsilateral side  
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Where does a epidural hematoma occur?   between dura and inner surface of the skull  
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Where does subdural hematoma occur?   between the dura matter and the arachnoid layer  
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Where does an intercerbral hematoma occur?   within the parenchyma  
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How can you tell the difference between a arterial and venous epidural hematoma, what is the main difference?   arterial=rapid onset of S/S, venous=slower onset  
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What S/S is specific to an arterial epidural?   brief lucid interval  
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What is a subdural hematoma?   Injury to the brain substance and parenchymal vessels, usually a vein  
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What are the different types of subdural hematomas?   acute=within 48 hours, subacute=within 2-14 days, chronic= over weeks or months  
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What are the S/S of an acute subdural?   decreased LOC, HA, ipsilateral pupil dilates and fixed  
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What are the S/S of a subacute subdural hematoma?   failure to regain consciousness  
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What are the S/S of a chronic subdural?   memory loss, somnolence, confusion, lethargy  
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Where do intracranial hematomas usually occur?   frontal and temporal lobes  
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What are usually the causes of intracranial hematomas?   HTN, aneurysms  
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What are the collaborative management goals?   management of IICP, treat cerebral edema and a timely diagnosis  
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What are the priorities of nursing management?   maintain patent airway, 02, asses neuro checks, reduce anxiety, GCS  
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What do the GCS indicate?   Score of 13-15= mild, 9-12=moderate, 3-8=severe  
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What to do for loss of corneal reflex?   lubercating eye drops, tapped shut, apply cold/warm compress to periorbital area for eccymosiss and edema, apply eye patch to reduce diplopia  
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What effect does hyerthermia have in regards to brain injuries?   it increases metabolism and increases cerebral vasodilation and ICP  
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How to asses and manage rhinorrhea and ottorrhea   HOB may be raised to reduce CSF pressure Place a loose collection pad under the nose or over the ear Do not sneeze or blow the nose No nasotracheal suctioning or NG tubes  
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What precautions should head injury patients be on?   seizure, skin if immobile, also bladder and bowl function management  
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What is euvolemia?   The maintenance of proper amount of blood in body  
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