TBI Flashcards
What is the Monroe Kellie hypothesis?
the sum of volumes of brain, CSF and intracranial blood is constant, therefore if one increases the other two could compress
What are the S/Sx of IICP?
- change of LOC
- agitation/confusion
- delayed responses
- pupil changes
- N/V
- HA
- loss of reflexes
- coma
- CUSHINGS TRIAD
What is cushings triad?
LATE sign of IICP:
1. rising BP with widened pulse pressure
2. bradycardia
3. bradypnea
What is decorticate posturing?
flex posturing (arms in), indicates damage between brain and spinal cord
What is decerebrate posturing?
extensor posturing (arms out), indicated damage to upper brain stem and is WORSE than decorticate
6 Types of TBI’s?
- concussion
- severe TBI
- open brain injury
- basilar fracture
- hematoma
- hemorrhage
S/Sx of concussion?
- altered level of consciousness
- changes in orientation
- pupil abnormalities
- change in vital signs
- headache, vomiting
visual changes
What assessment is required for concussion?
CT is done to rule out bleed
Treatment for concussion?
Rest, treat symptoms, pt should be roused and assessed frequently
How is severe TBI determined?
Glasgow Coma Scale (3-15)
How can outcomes of severe TBI vary?
Can cause emotional changes, problems with cognition, changes in sleep patterns
What is an open brain injury?
Injury caused by objects penetrating scalp, blunt trauma
What is a basilar fracture?
Fracture at base of skull
S/Sx of basilar fracture?
- raccoon eyes and/or battle’s sign
- bleeding from nose/ear/pharynx
What is raccoon eyes/Battle’s sign?
Raccoon eyes is bruising around eyes, battle’s sign is bruising behind ear
What is there a high risk for with regards to basilar fracture?
CSF leak from ears or nose
How is CSF leak tested?
- look for halo sign
- glucose dipstick
- beta 2 transferrin test
- note: CSF leak will present with HA
Describe epidural hematoma?
Blood collection in the space between skull and dura
Symptoms of epidural hematoma?
- brief LOC on initial impact
- then return to lucid state
- ICP increase/expansion of hematoma occurs
- pt has second change in LOC
Is epidural hematoma an emergency?
YES - surgical procedure needed to control ICP
Describe Subdural hematoma?
Collection of blood between dura and brain
Symptoms of subdural hematoma?
- change in LOC
- pupil changes
- coma
- increasing BP
Is subdural hematoma an emergency?
YES - surgical procedure needed to control ICP via Burr holes/craniotomy
Describe subarachnoid hemorrhage?
hemorrhagic stroke - bleeding into brain caused by either trauma or non traumatic case
Symptom of subarachnoid hemorrhage?
‘Worst headache of my life’, sudden and very severe pain
Treatment for subarachnoid hemorrhage?
control of ICP, craniotomy
Respiratory interventions for TBI?
-maintain airway and oxygenation
- balance suctioning since it increases ICP
Neuro assessment/vitals interventions for TBI?
- initially qh
- may give meds to manage ICP
- prevent vasospasm
- decrease cerebral edema
- manage temp but avoid shivering
- avoid hypotension with fluid bolus
What medication is given to prevent vasospasm?
Nimodipine
What meds are given to manage ICP?
anti-epileptics, sedation e.g. benzos, morphine
What medication is given to decrease cerebral edema?
Mannitol as a diuretic
What type of meds are given to avoid hypotension?
vasopressors
Describe positioning interventions for TBI?
- semi fowlers (HOB 30 degrees)
- neck neutral
- avoid knee/hip flexion
- exhale during repositioning
Fluid/electrolyte balance interventions for TBI?
- careful I/O’s
- daily weight
- monitor for sodium imbalance, hyperglycemia due to stress response
Nutrition interventions for TBI?
- tube feedings (watch aspiration risk)
- adequate protein intake for healing
Bowel/bladder interventions for TBI?
- reduce risk of constipation/IICP (stool softeners)
- avoid enemas
What meds are commonly given to reduce risk of constipation/IICP?
Colace, Senna
Interventions for immobility complications TBI?
- prevent infection
- prevent pressure ulcers
- prevent DVT
- PT/OT consult
