NEUROTRAUMA

Question 1

Define traumatic brain injury and list potential causes

Answer 1

A traumatic brain injury is a form of acquired injury that occurs from a sudden trauma or impact that causes direct damage to the brain. It can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters the brain tissue

Causes: falls, motor vehicle accident, violence, sporting injuries, bomb blast

Question 2

Identify the different areas of the brain and state what functions will be affected if injury is to occur

Answer 2

Brain stem: changes in HR, breathing, BP, vomiting and swallowing, digestion

Cerebrum: intelligence, learning, judgement, speech and memory, sense of learning, vision, skeletal muscle movements

Cerebellum: balance and coordination and posture

Question 3

Categories of TBI

Answer 3

Mild: GCS 13-15, slight nausea, confusion

Moderate: GCS 9-12, amnesia

Severe: GCS <8, poor patient outcomes, secondary brain injury

Question 4

Identify the types of TBI and provide a definition

Answer 4

Subdural haemorrhage (most common, bleeding into the subdural space)

Subarachnoid haemorrhage (bleeding into the subarachnoid space)

Extra Dural haemorrhage (bleeding between the skull and dura matter)

Contusions (bruise to the surface of the brain)

Diffuse axonal injury (Injury damaging the integrity of axon)
 Severe type of TBI
 Acceleration/deceleration
 Microscopic damage
 MRI diagnosis

Concussion (blow to the head)

Question 5

What is the Monroe Kellie Doctrine?

Answer 5

• Skull is a closed compartment
• Consists of CSF (10%), brain tissue (80%) and blood (10%)
• An increase in one should cause a decrease in one or both of the remaining two
• Disrupts the balance and equilibrium of the brain

pressure causes the brain stem to compress which then impacts individuals HR and breathing leading to eventual brain death due to the pressure.
So if one component increases, the other two decrease.

**hypothesis

Question 6

What is a secondary brain injury and list the potential causes

Answer 6

Follows initial event:
- Primary aim = prevent secondary brain injury
- Causes – physical/metabolic insults to the brain
- Intracranial affect after initial trauma
- Causes: hypoxia, ischemia, cerebral oedema, acidosis

Question 7

Contributors to poor outcomes in TBI

Answer 7

1. Hypoxia (Spo2 < 90% - GCS <8 = intubate)
2. Hypoperfusion/Hypovolaemia
3. Hypercapnia (Jeep patient at normocarbia 35-45mmHg, continuous capnography)
4. Hyperthermia (Elevations as small as 1-2 degrees can aggravate injury, temp <37)
5. Coagulopathy (Defect in clotting cascade, worsens injury, increases with IV fluids)

Question 8

What is ICP? And the normal values of pressure

Answer 8

Intracranial pressure;
the pressure exerted by fluids such as CFS, blood on the brain tissue
- normal: <20mmHg

If ICP is too low, the brian may sag downward, stretching the meninges and nerves, causing pain.
If ICP is too high, it can cause long term brain damage.

Question 9

Factors affecting ICP?

Answer 9

• Cerebral blood flow
• Cerebral venous return
• Oxygen
• Carbon dioxide
• Blood pH

Question 10

Nursing care of the patient with a TBI?

Answer 10

• 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)
• Avoid NSAID/aspirin
• Positioning
• Bed rails