N202 Unit 6 Part 2 TBI Flashcards
periorbital bruising
raccoon eyes
halo sign
clear draining that separates from bloody drainage (presence of CSF)
bruising of the peri-auricular (behind the ear) area
battle signs
Tx of Communicated & Compound Skull Fx
debride, abx, and crainioplasty prn
linear fx at base of skull, frequently crosses the sinus & tears the dura → leakage of the blood &/or CSF
Basilar skull fxu
With Basilar skull fx do NOT
pack the nose or the ear
blow nose
suction drainage
tearing of the brain tissue
Laceration
bruising of brain tissue
Contusion
Contusion of the brain stem–>
coma
Bleeding btwn dura mater & arachnoid layer
Subdural hematoma
3 types of Subdural hematomas
acute
subacute
chronic
Leading cause of TBI
Falls
moving object hits a stationary head.
Acceleration
only pt of contact that is injured
moving head strikes a stationary object
Deceleration
most common w/ MVA
Acceleration-deceleration
70% of all Skull Fx
Linear
Straight ln/ crack in the skull.
Linear
Tx for Linear Skull Fx
often bedrest
hematoma btwn skull & upper surface of dura
Epidural hematoma
Epidural hematoma
neurologic emergency
Can cause Death
Bleeding btwn dura mater & arachnoid layer
Subdural hematoma
3 Types of Subdural Hematoma
Acute
Subacute
Chronic
Acute Subdural Hematoma
S/S w/in 48h
drowsy & confused
Ipsilateral pupil dilates/ fixed.
Subdural Hematoma occurs w/in 2-14d; may have failure to regain conciseness
Subacute
Subacute Subdural Hematoma
2-14d
Failure to regain consciousness may be an indicator.
Late sign hypoglycemia
seizure, EKG changes
prevent alcohol S&S of W/D
Benzodiazepines
Dilantin, Phenobarb
Anticonvulsants
Seizures increase
cerebral metabolic rate, CBF, CBV (cerebral blood volume)
Tx of acute hypoglycemic episode in Unconscious Pt
Assess airway
Glucagon SQ, Amp D50 IV
Always follow institutional policy
Tx acute hypoglycemic episode in conscious its
PO Glucagon
Always follow institutional policy
rapid onset Polydipsia, polyuria, polyphagia Kussmaul Respirations ketones present metabolic acidosis BS (~600mg/dl)
DKA
Goal of tx of DKA
Decrease BS by 50 mg/dl/hr
Epidural hematomas most frequently occur
in the area of the temporal bone d/t the presence of the middle meningeal artery
s/s w/in 48h
Ipsilateral pupil dilates & becomes fixed.
acute subdural hematoma
Cluster Breathing
Upper Medulla
Biots breathing, depressed respirations, or gasping breaths
Medulla lesions
Apneustic breathing
lesions of lower pons
Central neurogenic hyperventilation
lesions in lower midbrain to midpons area
Cheyne-stokes
lesions deep inside the cerebral hemispheres & basal ganglia
Tracrium, Pavulon, Succinylcholine
Neuromuscular blockades
Ativan, Versed, Propofol (Diprivan), Morphine, Haldol
Analgesia
Pressure/Volume
Elastance
brain’s ability to accommodate changes in volume
Volume/Pressure
Compliance
amt of bld passing through brain tissue in one minute
CBF
~750ml blood/min
talk and die
epidural hematoma
bleeding btwn the skull and dura
epidural hematoma
Sudden transient mechanical head injury with disruption of neural activity & change in LOC. (NO STRUCTURAL DAMAGE)
Concussion
Widespread axonal damage–> axons are broken, attempt to repair, massive proliferation, → scaring.
dai
Cerebral Blood Flow (CBF) Cerebral Blood Volume (CBV) Intraabdominal & intrathoracic pressure Posture Blood gases (CO2 levels)- affect CBF
influence ICP
