Head Injury Flashcards
What is the initial nursing care of a patient w/ head injury?
Airway control, resuscitation & admission to the ICU
Explain “talk and die” syndrome
Present w/ GCS > 9-13
Initially talking and w/o significant signs of external injury
Rapidly deteriorate within 48 hours of injury
78-80% of cases from epidural haematoma
Have worse outcome than patients who present with TBI at onset
What’s Cushing’s Triad?
Acute entity seen in severely head injured patients w/ significant increased ICP and impending herniation
Resulting from: ischaemia to hypothalamus w/ poor perfusion to brain
Results in: sympathetic stimulation of the heart to correct poor perfusion Characterised by: progressive hypertension, bradycardia, irregular or impaired respiratory pattern
What is the recommended ICP?
< 20 mmHg
What degree should the head of the bed be at for a pt w/ an increased ICP?
30 degrees
Why are hypotonic fluids contraindicated to treat hypotension in a patient w/ a severe head injury?
?
Why is mannitol administered for severe head injury and when is it contraindicated?
Because if it’s potent diuretic properties - quickly reduces ICP
Contraindicated in Pts w/ severe heart failure, renal disease, pulmonary congestion or oedema, active intracranial pressure, dehydration and disturbance of blood-brain barrier
Explain secondary impact syndrome
Suffers a second head injury before the first injury has healed
1st injury: causes disruption of normal cerebral vascular autoregulation that causes increased cerebral blood flow
2nd injury: Pts develop rapid diffuse cerebral oedema (within 2mins), increased ICP and eventual herniation, coma and death
Explain post concussive syndrome
Constellation of symptoms that develops within 4 weeks of injury + may persist for months
Explain post-traumatic epilepsy
Seizure activity > 7 days from traumatic injury
What age group is most likely to present to the ED with a head trauma?
15-24 yo
What number on a GCS represents a MET call?
< 9
Explain the Monroe-Kelli hypothesis
The expansion of one compartment MUST be accompanied by a compensatory reduction in the volumes of the other compartments to maintain a stable ICP
What is a primary brain injury and give an example
Direct or indirect force to brain tissue resulting in cellular injury
E.g. Physical Trauma
What is a secondary brain injury and give an example
Systemic or intracranial process that contributes to the primary brain injury cycle and results in. Greater tissue damage
E.g. Systemic insult and intracranial insults
What is a systemic insult in relation to secondary brain injury
Hypoxia (PaO2 < 60mmHg), hypotension (SBP < 90mmHg), anaemia blood loss (dec O2 carrying capacity), hypo/hypercapnia (hyperventilation + vasoconstriction)
Seizures, electrolyte abnormalities, coagulopathy, infection, hyperthermia + iatrogenic
What is an intracranial insult in relation to secondary brain injury?
Intracranial hypertension, extra-axial lesions, cerebral oedema (peaks at 24-48 hours post injury)
Give examples of the mechanisms of injury for head trauma
Skull fracture, extra-axial lesions (extradural + subdural haematoma), intracranial haemorrhage, subarachnoid haemorrhage
Where is an epidural haematoma located and what are the main manifestations?
Between skull and dura mater
Head injury w/ LOC + lucid interval followed by deterioration
Lenticular shape on CT
What is a subdural haematoma located and what are the main manifestations?
Blood accumulation between dura mater and pia arachnoid mater
Increased risk in elderly + alcoholics due to dec brain volume
Hyper dense crescent shaped lesion
What is the diagnostic test that will allow for the best prognosis of a head injury to be determined?
CT scan
What are the routine diagnostic tests for a patient with a head injury and why?
Coagulation profile, FBC, U&Es, LFTs, ABGs, CT scan, MRI, x-ray
What are we going to include in the clinical assessment of a pt w/ head trauma
MIVT (mechanism of injury, injuries sustained, vitals, treatment), hx of LOC, FNO, GCS, PEARL, vomiting/nausea
What are the complications of head injury?
IICP causes brain herniation (Coning), secondary impact syndrome
