5.4 Traumatic Brain Injury (TBI) and Hemorrhage Flashcards
Traumatic Brain Injury (TBI)
- Any trauma involving blunt force or penetration of the head
- Causes change in LOC, mental status
Classification
- Open or closed
- Mild - Severe
- LENGTH OF TIME UNCONSCIOUS IS VERY IMPORTANT (if they did lose it)
Clinical Manifestations
- Is there leakage of CSF (watery discharge from nose/ears with halo appearance. If it tests positive for glucose it is CSF)
- Leakage of CSF means there is a crack somewhere, where it can leak out.
- Leading cause of death/disability among injured children
- Always worried about cervical neck injuries (immobilize spine)
- KEY IS PREVENTION
Long-Term Implications of Brain Injury
Complications
- Hemorrhage, Infection, Swelling, Herniation of Brain Stem
Long-Term Complications
Children/Adolescents
- Epilepsy
- Cognitive Impairment
- Learning/Behavioral/Emotional Problems
Young Children
- Cognitive deficits such as problem solving, sequencing, concrete thinking, visual-spatial organization
- Depends on how severe the injury was and how old the child is (regression of milestones)
TBI Etiology/Pathophysiology
- Most common cause is falls, motor vehicle accidents, biking accidents
- Education about seatbelts, looking to cross streets, helmets, protective equipment for sports, preventing shaking baby syndrome.
Clinical Manifestations of TBI
Minor Injuries
- Irritable, n/v, headache
Severe Injuries
- Increased ICP (Cushing’s Triad)
- Retinal hemorrhage
- Lack of movement of certain extremities
- Changes in VS - If change in RR, HR, Temp can indicate brain stem damage
- Compromised blood flow (increased in systolic pressure, widening, pulse pressure, bradycardia, irregular respirations)
- BIGGEST WORRY IS CHANGE IN RESPIRATORY EFFORT (DAMAGE TO BRAINSTEM)
Emergency Treatment for TBI
- ABCs first
- Immobilize cervical spine (do 2nd)
- Preform neuro exam and LOC
- Monitor VS
EMERGENT SITUATIONS
- Keep NPO incase of surgical interventions
- Pain management but do not give analgesics (opioids) or lower pain medications that may compromise LOC or respiratory effort.
- Fluid replacement and O2
- Seizure precautions
- Decrease stimuli in environment
Epidural Hemorrhage
- Hemorrhaging between the dura and skull
- Typically due to artery tear
- Presses brain down and inward
- Not often in infants/children so if seen it may be an indicator of abuse
- Diagnosed via CT Scan
MANIFESTATIONS
- Initial momentary unconsciousness
- Lucid period of normalcy for several hours
- After this there is a progressive decline to lethargy/coma
SYMPTOMS DEPEND ON AGE
Infant
- Irritability, vomiting, seizure, bulging anterior fontanels, lethargy
Child
- Irritability, vomiting, headache
Subdural Hemorrhage
- Bleeding between dura and arachnoid layer
- Typically due to vein tear
- More common. Develops more slowly and blood spreads out thin and wide (can cross suture line)
- Common in infancy due to birth trauma, assault, shaking baby syndrome, falls.
Acute - Associated with contusion/laceration
Chronic - More common than acute
SYMPTOMS
- Irritable, vomiting, bulging fontanels
- LARGER AMOUNT OF INTRACRANIAL BLEEDING BECAUSE IT CAN OCCUR SO SLOWLY AND SPREAD OUT MORE THINLY.
- CAN CAUSE HEMORRHAGIC SHOCK
TREATMENT
- Aspiration of blood
- Subdural drains
- Burr holes (craniotomy)
Assessment of TBI
- Pain levels
- How the injury occurred
- Did the patient lose consciousness and how long
- Post-injury symptoms
- Significant medical history
- Previous injuries
- Allergies
- Chronic Conditions
Types of TBI
Concussion - most common and most mild form of TBI (alteration in mental status with/without lose of consciousness)
- Most frequent cause in children is whiplash and sports-related activities
HALLMARK - Confusion/Amnesia
Complications
- Post-concussion syndrome
- Second impact syndrome
- Headache
- Concentration/Memory Disturbances
