Head Injury (Gas #14) Flashcards
Concussion
momentary interruption of brain function with or without LOC
s/s of a concussion
Photophobia (sensitivity to light), Amnesia, HA, N/V, blurry vision
Discharge planning for a concussion
once home, monitor for 24 hrs, wake them up q 2 hrs to monitor mental status, competent caretaker
How long does kid have to wait until he/she can play sport again after Sports related concussion
1 week WITH medical clearance
Second Impact Syndrome
rapid swelling after injury
Mild severity of concussion
transient loss or altered state of consciousness
Moderate severity of concussion
loss of consciousness more than 30 minutes
Severe severity of concussion
loss of consciousness lasting longer than 2 hours
Very severe severity of concussion
loss of consciousness lasting longer than seven days
<14 years of age when will deficits from a concussion resolve?
within 3 months; severe deficits within 5 years
Mild head injury Glascow Coma rating
13-15
Moderate head injury Glascow Coma rating
9-12
Severe head injury Glascow Coma rating
8 or less
Glascow Coma Scale
rating on eye opening, verbal response, best motor response; greater the # the better
FOUR scale stands for?
Full Outline of Unresponsiveness score
FOUR scale
motor and eye opening responses (pupil rxns, respiratory pattern
Balance Error Scoring
Can be used on the side-line to determine sports related head injuries; determines ability to play, checks for balance problems
Immediate head injury treatment
ABC’s, control bleeding-surgery intervention, Monitoring & controlling intracranial pressure, treat other injuries
Primary Injury
inital damage to the brain resulting from a traumatic event ex. contusions, lacerations, torn vessels
Secondary Injury
hrs & days after the initial injury. due to lack of 02 & nutrients to cells. Due to cerebral edema, ischemia, seizures, infection, hyperthermia, hypovolemia & hypoxia
Contusions/bleeds
intracranial hemorrhage; bruise on brain
How to get a contusion/bleed
direct trauma, shearing forces on arteries/veins,
what determines s/s & time when symptoms occur with a contusion/bleed
site & rate of bleeding determines s/s & time when symptoms occur
Epidural Intracranial bleed
bleed between dura & skull (burr holes are commonly used with this)
Subdural intracranial bleed
between dura & arachnoid mater (brain); may be slow or fast
Intracerebral intracranial bleed
in actual brain tissue ex. bullets or stab injury
Burr holes are commonly used with which intracranial bleed?
Epidural and large acute subdural hematomas
4 things you assess with Intracranial Bleed
1.)altered LOC 2.) changes in sensory or motor function 3.) pupil change 4.) vs changes
Acceleration injury
The head is struck by a moving object
Deceleration injury
when the head hits a stationary object
Acceleration-deceleration (coup-countercoup phenomenon)
occurs when the head hits an object & the brain “rebounds” within the skull
Penetrating Head injury
open brain injury; broken bones-youll see gray matter
Closed head concussion (blunt)
a momentary interruption of brain function with or without loss of consciousness due to the blow to the head or a acceleration-deceleration injury
Intracranial hemorrhage examples
Epidural, subdural, Intracerebral
Skull fractures are classified as
open (dura is torn); closed (dura isnt torn) & 1)Liner 2)Comminuted/Depressed 3)Basilar
Linear (Simple) Fractures, is dura intact? what can cause this?
most common, dura usually intact, subdural or epidural hematoma frequently underly the fracture
Communited fractures
the bone is crushed into small fragmented pieces
Depressed fractures
there is an inward depression of bone fragments
with Communited/Depressed fractures is dura intact? what may be in brain tissue?
dura may or may not be intact, bone fragments may penetrate into the brain tissue
Where do basilar fractures occur?
usually at the base of the skull, may involve the frontal sinus or temporal bone
Manifestations of CSF leakage with Basilar fractures include
Rhinorrhea or otorrhea (test for glucose), “Halo” sign
“Halo sign with basilar fractures
observe for blood tinged fluid, CSF dries in concentric rings on gauze or tissues
Basilar fractures
if dura is disrupted, CSF may leak through tear; “Halo” & Battles sign may appear
Battles sign with basilar fractures
seen several days after basilar fracture. there may be bloody drainage from ear right after fracture occured
Craniotomy
part of skull is removed in order to evacuate chronic subdural hematomas
Cushings response
when cerebral blood flow decreases significantly when brain is ischemic, it triggers an increase in arterial pressure to overcome the ICP
Cushings Triad
brain trying to stabilize and fails; bradycardia, HTN, bradypnea
3 s/s of cushings response
1)increase in systolic pressure 2)increase widing pulse pressure (S&D #s getting farther away) 3)bradycardia, bradyonea
Brain stem function
automatic functions- heart rate,, breathing, swallowing, motor & sensory pathways
Brain Stem consists of?
Mid-brain, Pons, Medulla oblongata
Decorticate posturing & location
abnormal flexion of upper extremities; indicates damage to upper midbrain
Decerebrate posturing & location
extreme extension of upper & lower extremities & indicates severe damage to brain @ lower midbrain & upper pons
Locked in syndrome
a lesion affecting the pons or mid brain that causes tetraplegia & inability to speak
