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3007 Critical Care > Neurotrauma > Flashcards

Neurotrauma Flashcards

1
Q

What is a Traumatic brain injury (TBI)?

A

= a form of acquired brain injury, occurs when a sudden trauma causes damage to the brain.
- Can be caused when the head suddenly and violently hits an object or when an object pierces the skull and enters the brain tissue

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2
Q

Anatomy of the brain?

A
  • grey & white matter
  • 3 parts = Brainstem, cerebellum, cerebrum
  • 4 lobes = Frontal, parietal, temporal, occipital
  • R & L Hemispheres
  • 12 Crainal nerves
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3
Q

TBI severity (Categories)

A

Mild = GCS 13-15
Moderate = GCS 9-12
Severe = GCS <8

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4
Q

Three main parts of the brain?

A
  1. Brain stem = changes in HR, breathing, BP, Vomiting, swallowing & Digestion
  2. Cerebrum = intelligence, learning, judgement, speech & memory, hearing, vision, taste & smell, skeletal muscle movements
  3. Cerebellum = balance, coordination & posture
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5
Q

Pathophysiology of the Brain?

A

— skull is rigid compartment which holds everything
— Any changes to blood, CSF, Brain, volumes creates pressure build up
— Pressure on the Brain leads to death

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6
Q

What is cerebral blood flow?

A

— brain has the ability to control its blood supply to match its metabolic requirements
- vasoconstriction and dilation
- CBF increases with
— increase metabolic rate
— Hyperthermia
— seizures
— pain + anxiety

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7
Q

What is cerebrospinal fluid (CBF)?

A
  • purpose = buffer —> thick and buffers the brain through movement (protection
  • absorbs
  • if blocked = increase of pressure = problem
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8
Q

Types - haemorrhage of the brain

A

Focal injuries
1. Haematoma
a) Epidural haematoma
b) Subdural Haematoma
c) Subarachnoid haemorrhage
2. Cerebral Contusions
3. Meningitis

Diffused injuries:
1. concussion / mild TBI
2. Diffuse atonal injury DAI

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9
Q

Describe the types of haematomas TBIs?

A
  1. Haematoma: haemorrhage of the brain
    a) Epidural haematoma (ARTERY) —> middle meningeal artery rupture
    — usually due to blow to side of head at pteranodon (thinnest part of skull)
    — Rapidly expanding
    b) Subdural haematoma (Veins) —> tears in bridging veins that cross the subdural space
    — slower symptom onset due to slower nature of bleeding from vein
    c) Subarachnoid haemorrhage —> bleeding into the subarachnoid space = raised ICP
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10
Q

What is cerebral contusions?

A
  1. Cerebral Contusions —> bruise on surface of the brain
    — caused by movement in cranial vault & evolves over time (12-14 hrs to appear on CT)
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11
Q

What is menegitis?

A
  1. Meningitis —> inflammation of the meninges of the brain/ spinal cord or both.
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12
Q

Describe concussion/ mild TBI?

A
  1. Concussion/ mild TBI
    — direct blow
    — Diffuse injury
    — transient amnesia / LOC
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13
Q

Describe Diffuse atonal injury DAI

A
  1. Diffuse atonal injury (DAI)
    — Mild-Severe TBI
    — Diffuse = microscopic damage
    — damages integrity of axon
    — ICU ventilated for long period
    — MRI diagnosis
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14
Q

Mechanism of injury TBI

A

— Blunt (common in ED)
— penetrating (bullets, knives)
— MVC
— Falls
— Assults
— Less common:
smoke inhalation, burns, explosion)

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15
Q

What is primary injury TBI?

A

= injury at time of event
— Primary irreversible injury
— only treatment is prevention of secondary injury —> once damage is done you may not be able to fix

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16
Q

What is secondary injury?

A

Secondary injury = Follows the initial even (PREVENTABLE)
— e.g. hypoxia, hypercapnia, hypotension (CCP > 60mmHg), metabolic changes

17
Q

Is concussion a diffuse or focal bleed?

A

= diffuse

18
Q

Can diffuse axonal injury be seen on a CT scan?

A

= no

19
Q

Is epidural haematoma an arterial or venous bleed?

A

= Arterial

20
Q

Is subdural haematoma an arterial or Venous bleed?

A

= Venous

21
Q

Can cerebral contusion be seen on a CT scan?

A

= yes appears over time

22
Q

After a positive CT scan do all patients need an operation?

A

= No small bleeds may need to be watched

23
Q

What are the causes of a secondary brain injury?

A

— hypoxia
— hypercapnia
— hypotension
— temperature (hypothermia/ hyperthermia)

24
Q

What is the normal range for ICP?

A

= >20mmHg

25
Q

Factors that affect ICP

A

Factors affecting ICP
- cerebral blood flow
- cerebral venous return
- oxygen
- carbon dioxide blood pH

26
Q

Preventing Hypoxia?

A
  • Below 8 GCS = intubate
  • SPO2 above 90%
  • RSI with c-Spine protection
  • ensure adequate mechanical ventilation
27
Q

Prevent hypercapnia?

A
  • causes cerebral vasodilation and increase ICP
  • keep patient at normocarbia 35-45 mmhg
  • continuous capnography
28
Q

Prevent hypotension?

A
  • above 90 mmHG
  • decrease cerebral perfusion pressure
  • decreased oxygenation to cerebral tissue
29
Q

Prevent Hyperthermia?

A
  • temp increase linked to raised ICP
  • ICP falls at temp below 37
  • active cooling
30
Q

Prevent coagulopathy?

A
  • Detect clotting cascade
  • worsens injury
  • increases with IV fluids
31
Q

What is the primary survey for TBI?

A
  1. Airway & C-Spine stabilator
  2. Breathing (ensure high oxygenation & consider pneumothorax)
  3. Circulation (use blood products & inotropes in ICU if needed)
  4. Disability (AVUP, GCS)
  5. Exposure (Wounds, bleeding, insert IVC)
  6. Re-evaluate continuously
32
Q

What is the treatment for severe TBI?

A
  • Sedation
  • Fluid management
  • Osmotherapy
  • Hypothermia
  • Surgery
  • hyperventilation
  • steroids
33
Q

What is the treatment for raised ICP?

A

Treatment to reduce ICP
- Reduce cerebral oedema (osmotherapy)
- promote venous return
- reduce activity associated with elevated ICP
- reduced cerebral metabolic rate
- reduced hyperthermia
- management of pain and agitation
- risk of hypertension

34
Q

What is the ongoing nursing management of TBI?

A

Ongoing management
- sedation/ analgesia
- Imaging diagnosis
- monitor MAP
- observe signs of impending
- herniating

35
Q

Nursing care for TBI?

A
  • GCS hourly consistency
    • Head to 30 degrees
    • Temperature (high temp = oedema)
    • Cervical collar/ clearance
    • Cluster care
    • Adequate analgesia (prevent ICP)
    • DVT prophylaxis
    • TEDS
    • Calf compressors until fully ambulatory
    • Chemical prophylaxis (heparin
    • Avoid NSAID/ Aspirin
    • Positioning
    • Foot splints
    • Bed rails / restraint
    • Pillows
    • Regular passive movement
    • Families are important
    • Reduced stimulation
    • Consistency in routine
    • Rest
    • Familiar objects/ photos
    • Maintain safe distance
    • Develop plan
36
Q

What is the long term treatment for TBI?

A

Long term treatment:
- promote return to functional and independent life (social, emotional, physical and relationship)
- must be in conjunction with family

37
Q

Take home messages for TBI?

A

Take home message:
- regular monitoring
- secondary injury prevention
- reduction ICP
- avoid hypoxia/ hyperthermia
- early rehab
- nursing management
- reduced simulation
- cluster care

3007 Critical Care (10 decks)

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