Neurological Alterations (Traumatic Brian Injury - TBI) Flashcards
What are TBI’s defined as ?
Any injury that results in damage to the bran
TBI’s can be either _______ or ________ ?
Open or Closed
How is a Closed TBI defined ?
The brain is injured, But the skull is not broken, fractured, or penetrated.
The Dura is not Torn
How is a Open TBI defined ?
Brain injury, where the skull IS broken, fractured, or penetrated.
The Dura IS torn in a penetrating injury
What is important to note with Open TBI’s ?
The Location of the skull fracture
____________ skull fractures are the most serious ?
Basillar
With Basillar skull fractures, where would you see bleeding ?
EENT
______________ is a sign of a skull fracture ?
Battle’s sign
What is a Battle’s sign ?
Bruising over the mastoid bone (bone behind the ear)
What are other signs of Open TBI’s ?
- Raccoon eyes (peri-orbital bruising)
- Cerebrospinal rhinorrhea
What is Cerebrospinal-rhinorrhea ?
What do we want it to do ?
Leaking spinal fluid from your nose
Want it to flow freely until it heals itself
How do you tell CSF from other types of drainage ?
CSF will be positive for glucose and the halo test
What is the Halo test ?
A ring or halo around a blood spot on sheets
What types of skull fractures usually do not require surgery ?
Non-depressed
Depressed skull fractures usually require what ?
Surgery
What are two types of Focal injuries that are seen with TBI’s ?
- ) Contusions
2. )Hematomas
What are Contusions usually seen with ?
Seen with Blunt trauma or acceleration-deceleration injuries like whiplash
With Contusion injuries, the brain is ________ and ___________ ?
Bruised and damaged
A small hematoma that develops rapidly may be what ?
Fatal
A massive hematoma that develops slowly may do what ?
May allow the client to adapt
A fast and acute bleed will cause what ?
Instant ICP
What is the Pathophysiology of an Epidural Hematoma ?
A rupture or laceration of the middle meningeal artery
(fast bleeder under high pressure)
What is the progression of symptoms in a client with an Epidural Hematoma ?
Injury –> loss of consciousness –>Recovery period –> Bleeding into their head (increased ICP) –> Can’t compensate anymore –> Neuro changes –> Coma
What are the Tx’s for an Epidural Hematoma ?
- Burr holes (to remove the clot, stop the bleeding, and control the ICP)
What types of questions do you want to ask to someone with an Epidural Hematoma ?
- Did they pass out and stay out ?
- Did they pass out, wake up, and pass out again ?
- Did they just see stars ?
An Epidural Hematoma is what ?
An Emergency!
What is the Pathophysiology of a Subdural Hematoma ?
A collection of blood between the dura and the brain
Subdural Hematomas are usually what types of bleed ?
Venous bleeds (Slower than an arterial)
Subdural Hematoma can be what ?
- acute (fast)
- Subacute (medium)
- Chronic (slow)
What are the Tx’s for a Subdural Hematoma ?
- Acute or chronic = immediate craniotomy to remove clot and control the ICP
Chronic Subdural Hematomas do what ?
Immitates other conditions (ex: appear drunk, stroke, etc)
- Bleeding and compensating - Neuro changes = compensation maxed out
What are two types of TBI’s ?
a. ) Foacal injuries
b. ) Diffuse Brian injuries
What is a type a Diffuse Brian Injury ?
Concussion
What is a concussion ?
Temporary loss of neurologic function with complete recovery
True or false:
With a concussion you will have a short period of unconsciousness or they may just get dizzy and see spots ?
True
What signs do you want to teach the caregiver that require them to bring the client back to the ED ?
- *Difficulty awakening/speaking
- Confusion
- Severe headache
- vomiting
- pulse changes
- Unequal pupils
- one-sided weakness
(signs that the ICP is going up)
