Acute Brain Injury Flashcards
what are some causes of non-traumatic brain injury?
tumors, vascular causes such as CVA, cerebral anoxia cardiac arrest, toxic poisoning or OD, metabolic or hepatic encephalopathy, infection meningitis
what are some traumatic causes of brain injury?
- concussions (mild brain injury)
- diffuse axonal injury (DAI, often end up in vegetative state)
- hematomas (epidural, subdural, intracranial (most common))
what causes an increase ICP?
Cerebral edema
hemorrhage
biochemical response and infection
leading to compression of brain tissue
what is the most common way to monitor ICP?
intraventricular catheter/extraventricular drain (EVD) (SYSTEM MUST BE LEVELED WITH INSERTION SITE INTO PATIENT; also used to drain CSF to control ICP)
what is a normal ICP level?
10-15 mmHg
An ICP level of _____causes brain death
> 40 mmHg for 4hrs
what happens when Cerebral Perfusion Ratio is <70-100 mmHg?
decreased oxygenation to cerebral tissue
Mean Arterial Pressure (MAP) must be above___mmHg to maintain adequate CPP
90
Surgical management of acute brain injury includes?
burr holes
craniotomy
bone flap removal
what are some precautions and contraindications after bone flap removal?
NEVER turn to affected side
Pt not allowed to put pressure over the area
Only tilt to affected side or buffer head with foam
May require helmet during mobilization
what can raise ICP?
- Head movement
- Coughing
- Suction: respiratory depression–>increases arterial CO2–>causes vasodilation increasing bloodflow–> increases ICP (monitor carefully)
For ICP control always…….
- consult for mobility and positioning orders
- request bolus of sedation during Rx
- maintain HOB at 30 degrees
- move pt slowly
- -if EVD in situ close stopcock before altering HOB or mobilizing
- turn pt every 2 hours, maintain head in neutral position
decorticate posture
arms flexed
legs extended
decerebrate posture
extensor tone in UE and LE
what are some effects of extended positioning?
thinning of cartilage, atrophy of muscles and weakness, reduced joint lubrication
PT management to prevent contractures
Place muscles in lengthened position for enough time
-20min to 12 hours a day
Splinting and casting to maintain ROM
-resting splints 6-8 hrs at least , preferred overnight
PROM with joint approximation and touch – to maintain body schema and awareness
what decreases ICP?
hyperventilation –decreases pressure and therefore ICP, but also causes hypoxia so short term fix
what does a low INR (international normalized ratio) mean? normal is 0.9-1.3
decreased coagulation of blood, reduced ability to heal
restricted activity and on bed rest
INR 2-3
patient on warfarin
