Chapter 63 Management of Patients w/ Neurologic Trauma

Question 1

Head Injury

Answer 1

A broad classification that encompasses any damage to the head as a result of trauma
- Does not necessarily mean a brain injury is present

Question 2

Traumatic Brain Injury (TBI)

Answer 2

AKA Craniocerebral trauma

Describes an injury that is the result of an external force & is of sufficient magnitude to interfere with daily life and prompts the seeking of treatment

Question 3

Health Promotion: Preventing Head & Spinal Injuries

Answer 3

Advise drivers to obey traffic laws and to avoid speeding or driving when under the influence of drugs or alcohol.

Advise all drivers and passengers to wear seat belts and shoulder harnesses
- Children younger than 12 years should use an age/size-appropriate system in the back seat.

Caution passengers against riding in the back of pickup trucks.

Advise motorcyclists, scooter riders, bicyclists, skateboarders, and roller skaters to wear helmets.

Promote educational programs that are directed toward violence and suicide prevention in the community.

Provide water safety instruction.

Educate patients about steps that can be taken to prevent falls, particularly in older adults.

Advise athletes to use protective devices
- Recommend that coaches be educated in proper coaching techniques.

Advise owners of firearms to keep them locked in a secure area where children cannot access them

Question 4

What are the two forms of traumatic brain injuries?

Answer 4

Primary & secondary

Question 5

Primary Brain Injury

Answer 5

Consequence of direct contact to the head/brain during the instant of initial injury, causing extracranial focal injuries as well as possible focal brain injuries from sudden movement of the brain w/in the cranial vault

Examples of Extracranial Focal Injuries: Contusions, lacerations, external hematomas, & skull fractures

Examples of Brain Injuries that Occur from Sudden Movement w/in Cranial Vault: Subdural hematoma (SDH), concussion, diffuse axonal injury (DAI)

Question 6

Secondary Brain Injury

Answer 6

Evolves over the ensuing hrs & days after the initial injury and results from inadequate delivery of glucose and O2 to the cells.

Question 7

What are the 3 key areas of focus w/ early treatment of TBI?

Answer 7

Identification, prevention, & treatment of secondary brain injury

Question 8

What are the 3 components of the cranial vault?

Answer 8

Brain, blood, & CSF

Question 9

Monroe-Kellie Hypothesis and ICP (Intracranial Pressure)

Answer 9

Cranial vault is a CLOSED system: If 1/3 components increases in volume, at least one of the other two MUST decrease in volume or the pressure will increase
- Any bleed/swelling w/in the skull increases the volume of contents w/in the skull-> ICP increases

If the pressure increases enough, it can cause displacement of the brain through or against the rigid structures of the skull
- Restriction of blood flow to brain-> decrease O2 delivery & waste removal

Cells w/in brain become anoxic: Produce ischemia, infarction, irreversible brain damage-> brain death

Question 10

Scalp Injury

Answer 10

Typically classified as minor injury
- Diagnosed via examination, inspection, & palpation
- Acts as potential portal of entry for organisms that cause intracranial infections

Area is irrigated before suturing to remove debris & decrease infection risk

Scalp blood vessels constrict poorly-> bleed a lot

Trauma may result in:
- Abrasion
- Contusion
- Laceration
- Subgaleal hematoma: Usually reabsorbs & does not need any specific treatment

Avulsion may be potentially life-threatening & is treated as EMERGENCY!!

Question 11

Abrasion

Answer 11

Brush injury

Question 12

Subgaleal Hematoma

Answer 12

Hematoma beneath layers of tissue of the scalp

Question 13

Avulsion

Answer 13

Tearing away of the scalp

Question 14

Skull Fracture

Answer 14

A break in the continuity of the skull caused by forceful trauma

May occur w/ or w/out damage to the brain

Classified by type & location
- Types: Linear, comminuted, & depressed
- Location: Frontal, temporal, & basal

Can be open or closed

Question 15

Linear Fracture

Answer 15

AKA Simple Fracture

A break in the continuity of the bone

Question 16

Comminuted Fracture

Answer 16

Refers to a splintered or multiple fracture line

Question 17

Depressed Fracture

Answer 17

Occurs when the bones of the skull are forcefully displaced downward

Can vary from slight depression– bones of the skull being splintered & embedded w/in brain tissue

Question 18

Basal Skull Fracture

Answer 18

Fracture of the base of the skull

Question 19

What does an open skull fracture indicate?

Answer 19

Indicates scalp laceration or tear in the dura (bullet, ice-pick)

Question 20

What does a closed skull fracture indicate?

Answer 20

The dura is intact

Question 21

Clinical Manifestations of Skull Fractures

Answer 21

Persistent, localized pain

May or may not produce swelling in the location of the fracture

Basal fracture: Tend to traverse the paranasal sinus of frontal bone/ middle ear-> frequently hemorrhage from the nose, pharynx, or ears
- Blood may be found under the conjunctiva
- Battle Sign

Question 22

When are basal skull fractures suspected?

Answer 22

When CSF escapes from the nose (CSF rhinorrhea) and ears (CSF otorrhea)

Drainage can lead to meningeal infection if organisms gain access to the cranial vault via nose, ear, or sinus via tear in the dura