GF13: Neuro Head Injury 2 Flashcards
A whiplash injury is formally known as…
Coup-contrecoup injury
Describe a coup-contrecoup injury.
- Damage from coup-contrecoup injury occurs when the brain moves inside the skull due to high-energy or high-impact injury mechanisms.
- Contusions or lacerations occur both at the site of the direct (primary) impact of the brain on the skull (coup) and at a second area of damage on the opposite side away from injury (contrecoup), leading to multiple contused areas.
- Contrecoup injuries tend to be more severe.
Seizures can occur because of a brain contusion, particularly when the injury involves…
the frontal or temporal lobes
What is important to keep in mind regarding anticoag use in TBI?
It is contraindicated as it can cause more bleeding
Why are we concerned about risk for falls with elderly pts?
- Use of anticoags is common
- If pt falls and obtains a TBI that bleeds, the anticoags can worsen the injury
What are the s/s of epidural hematoma?
- Classic s/s of epidural hematoma:
- an initial period of unconsciousness at the scene, with a
- brief lucid interval followed by a decrease in LOC.
- Presence of rhinorrhea or otorrhea
- Other manifestations may be a headache, nausea and vomiting, or focal findings.
What are the 3 categories of subdural hematomas?
acute, subacute, or chronic
What is the timing, progression and tx for an acute subdural hematoma?
- Timing: manifests within 24 to 48 hours of the injury
- Progression: immediate deterioration
- Tx: Craniotomy, evacuation and decompression
What is the timing, progression and tx for a subacute subdural hematoma?
- Timing: usually occurs within 2 to 14 days of the injury.
- Progression: decline in mental status as hematoma develops. Progression dependent on size and location of hematoma
- Tx: evacuation and decompression
What is the timing, progression and tx for a chronic subdural hematoma?
- Timing: develops over weeks or months after a seemingly minor head injury
- Progression: nonspecific, non-localizing progression. Progressive change in LOC
- Tx: evacuation and decompression, membranectomy
Why are pts w/ a hx of alcohol abuse more prone to subdural hematomas?
- Increased risk of falls
- Alcohol is a vasodilator and will promote bleeding injuries
What are the immediate interventions for TBI pts?
- ABC’s
- Stabilize cervical spine
- Give O2
- Establish IV access with 2 large-bore catheters to infuse fluids/meds
- Intubate if GCS <8
- Control external bleeding with sterile pressure dressing
- Remove pts clothing
Why would we need to pay attention to keeping a pt normothermic?
- Temperature control center of brain may be damaged
- Fever can quickly climb via feedback loop
What are two typical points that intubation would be called for w/ TBI pts?
- GCS ≤8
- Impaired/absent gag reflex
What is the continual monitoring after emergent tx for TBI is completed?
Monitor VS, LOC, O2 sat, Cardiac rhythm, GCS score, pupil size and reactivity
