Trauma Flashcards
What are stem cells?
have the potential to develop into every type of cell in the body
Current stem cell research
examining the use of stem cells that could possibly be used to replace the neurons and glial cells that die after spinal cord injury.
Adult stem cells
multipotent, with a more limited capacity to differentiate into specific cell types
- Blood stem cells only make all specialized blood cells (WBC, RBC, etc), bone stem cell only make all specialized bone cells (osteoclasts, osteoblasts, etc)
Embryonic stem cells
pluripotent, meaning they have the potential to develop into any type of cell in the body, making them highly versatile for regenerative medicine
What are induced pluripotent stem cells?
adult cells that have been genetically manipulated in the lab to act like embryonic cells
What is induced pluripotency transduction?
a process in which adult cells, such as skin or blood cells, are reprogrammed to become pluripotent stem cells. This reprogramming involves the introduction of specific genes or factors into the adult cells, which ‘induce’ them to revert to a more primitive, pluripotent state, similar to embryonic stem cells
Ethical Implications/Considerations of Stem Cell Research
Taken from IVF
- Obama lifted a 8 year ban on stem cell research that restricted federal funding
- This moves opens the door for research to access 10 billion dollar for biomedical research
- Opposition to this moves states if an embryo is a life, then no government has the right to sanction their destruction for research
What determines the type of spinal cord lesion
- mechanism of injury
- direction of forces
Define Complete Spinal Cord Injury
A complete spinal cord injury produces total loss of all motor and sensory function below the level of injury.
_____ of all spinal cord injuries are complete
1/2
True or false: in a complete spinal cord injury the cord is cut and/or transected
False
the spinal cord is rarely cut or transected; bruising/swelling/bone fragments around cord decreasing perfusion via pressure to glial cells more commonly causes loss of function
What commonly causes loss of function in spinal cord injuries
bruising/swelling/bone fragments around cord decreasing perfusion via pressure to glial cells more commonly causes loss of function
True or false: the original presentation of function following an SCI is the level of function the patient has permanently
False
Once swelling from initial injury subsides, mobility and sensation can increase. Need to await for prognosi
Define Incomplete Spinal Cord Injury
there is some functioning below the primary level of the injury
may be able to move one limb more than another, may be able to feel parts of the body that cannot be moved, or may have more functioning on one side of the body than the other.
What is helpful in predicting what parts of the body may be affected by paralysis/loss of function
Level of injury
Incomplete injuries there will be some ________ in these prognoses.
variation
True or false: a break in vertebra indicates a SCI
False: Can break vertebra without damage to cord
Cervical injuries result in
Quadriplegia
At C3 and above level requires
ventilator support
C5 injuries result in
result in shoulder and biceps control, but no control at the wrist or hand. diaphragm function still present.
_________ is still present when injury at C-5.
Diaphragm function
Injuries at C6/C7 result in
Quadriplegia, some function of upper extremities, sensory level lost below sternum
SCI to thoracic level results in
paraplegia, with the hands not affected.
SCI to T1-T8 result
most often control of the hands, but poor trunk control as the result of lack of abdominal muscle control.
SCI to T9-T12 result in
good truck control and good abdominal muscle control. Sitting balance is very good
SCI to lumbar/sacral region
decreasing control of the hip flexors and legs.
True or false: following SCI patients tend to struggle most with altered mobility/sensation/paralysis
false
What other changes than mobility/sensation/paralysis do SCI patients struggle with most
- bowel/bladder dysfunction
- sexual functioning (men decreased fertility, womens not affected)
- low BP/inability to regulate
- inability to regulate temperature
- inability to sweat below injury level
- chronic pain
4 components of SCI diagnosis
- neuro exam for level of injury
- reflexes
- spine x ray
- CT/MRI
What is autonomic dysreflexia?
A complication related to SCI in which various triggers cause reflexes - occurs when there is an abnormal, exaggerated response of the autonomic nervous system to a noxious stimulus or irritation below the level of the spinal cord injury
Definition and triggers associated with autonomic dysreflexia
a dangerous syndrome involving an overreaction of your autonomic nervous system
- distension of the bladder (most common)
- bladder or kidney stones
- a kink in a urinary catheter, - infection of the urinary tract,
- fecal impaction,
- pressure sores
- an ingrown toenail,
- fractures
- menstruation
- hemorrhoids
Reason for corticosteroids in SCI treatment
reduce swelling that may damage the spinal cord.
dexamethasone or methylprednisolone
2 reason for surgery in SCI treatment
- remove fluid or tissue that presses on the spinal cord (decompression laminectomy).
- needed to remove bone fragments, disc fragments, or foreign objects or to stabilize fractured vertebrae
Beyond drugs and surgery, what are the other components of SCI treatment?
- bedrest to allow spinal bones to heal
- address muscle spasms, care of skin, bladder/bowel dysfunction
- rehab
What is the most common head injury?
Concussion-Mild Brain Injury
Define concussion
- A mild injury to the brain caused by rapid movement of the head so that the brain is injured by hitting the inside of the skull.
- Traumatic induced alteration in mental status
Simple test to assess for concussion
closing your eyes and holding balance on one leg; concussed individuals are unable
What are the most common EARLY signs and symptoms of a concussion?
confusion, amnesia, N/V
What is perceived as the most common early sign and symptom of a concussion?
Loss of consciousness
Early signs and symptoms of concussion
- General confusion and amnesia are most common signs
- Nausea and vomiting very common sign
o Kid falls, and throws up = likely has concussion - Dizziness and/or “seeing stars”
- Strange behavior and unusual emotions
- Slurred speech
- Headache
- Slow to respond to questions
- Lack of coordination and balance
- Loss of consciousness is not most common; perceived
What is Postconcussive Syndrome of Childhood (PCS)
symptoms do not always show up immediately (2-12 hours post injury)
Symptoms of PCS?
- Delayed lethargy, irritability, and behavioral changes-irritability.
- Headache, dizziness, vomiting are common.
- Depression, anxiety can present as “late symptoms” because they generally do not occur immediately after the injury.
When is PCS diagnosed?
after three months of persisting symptoms
What is second impact syndrome?
An extremely rare condition in which the brain swells rapidly and catastrophically after a person suffers a second concussion before symptoms from an earlier one have subsided. The deadly second blow may occur days or weeks after initial concussion
What occurs in second impact syndrome?
Massive cerebral bleed occurs because brains arteries lose ability to regulate diameter.
Considerations to prevent second impact syndrome
Children must be completely symptom free before return to sport
What is chronic traumatic encepholpathy?
Cumulative Effects of Concussions over a Period of Time
a degenerative (death of nerve cells over time) brain condition that results from repeated head injuries, such as concussions. It is most commonly associated with contact sports like football and boxing but can also occur in military veterans and others exposed to head trauma. CTE is characterized by the accumulation of abnormal protein deposits in the brain, leading to a range of cognitive, emotional, and neurological symptoms that can worsen over time.
Symptoms and impact of CTE
Irritability, impulsivity, dementia
What is increased ICP and what is it due to?
Increase in the normal brain pressure.
This can be due to:
- an increase in cerebrospinal fluid pressure
- force exerted by brain tissue,
- CSF and blood within the cranial vault.
What can increased ICP lead to?
Decreased cerebral perfusion pressure
- Amount of pressure needed to ensure adequate O2 and nutrient delivery to the brain
INCREASED ICP REDUCES BLOOD FLOW TO THE BRAIN
What protective factors are there for children under 3 regarding increased ICP
- Up to 2-3 skull is not fully formed (fontanelles); good things because skull will expand. Following ossification, if brain is swelling there is nowhere to swell
Early signs of increased ICP
o Headache
o Vomiting
o visual disturbances (diplopia and blurred)
o slight v/s changes (decreased pulse, increased BP)
o slight LOC change
o seizures
Signs of increased ICP in infants/young toddlers
cannot verbalize headache, visual disturbances, slight LOC changes
- bulging fontanelles
- increased head circumference
- irritability/high pitched crying
- dilated scalp veins
- widened sutures
Late signs of increased ICP
o significant ↓LOC
o ↓ motor and sensory responses
o Bradycardia
o irregular respirations/Cheyne Stokes
o posturing
o fixed and dilated pupils
Assessment for increased ICP
- ABC - priority to guide intervention
- LOC - most important indicator of neuro changes (not cry)
- head circumference < 3y0
- Vitals
Vital sign changes are ______ of increased ICP
late sign
What is Cushing’s Triad?
Changes in vital signs that occur with increased ICP
a set of three classic signs seen in cases of increased intracranial pressure (pressure inside the skull): hypertension (high blood pressure), bradycardia (slow heart rate), and irregular, erratic breathing
What are the 3 components of Cushing’s Triad?
- bradycardia
- widening pulse pressure: an increase in the difference between systolic and diastolic pressure over time
- irregular respirations
Diagnosis of ICP
MRI/CT
Lumbar Puncture
Normal ICP
1-10mmHg
What ICP level is considered abnormal
Over 15mmHg
What is a TBI
Head trauma leading to brain injury is an important cause of morbidity and mortality in childhood.
Related to ICP
What are the most common causes of TBI in childhood?
- falls
- sports
- hit on the head
- bike
- MVA especially as pedestrian
Considerations when child is brought in with TBI and parents state it was a fall
Must have fallen from at least 3 feet to cause
Determine if injury was intentional
Symptoms of TBI
- Changes or impaired in LOC
- Headache
- Amnesia
- Disorientation or confusion
- Vomiting
- Blurred vision
- Seizures
What is an intracranial injury and what are the signs?
A worsened TBI
- Prolonged loss of consciousness
- Disorientation, confusion; amnesia
- Worsening headache
- Repeated or persistent vomiting
Severe TBI is indicated by what 4 things
GCS of 8 or less
post traumatic amnesia greater than 24 hours
coma
increased ICP
4 components of pediatric GCS
- eye opening
- best motor response
- best response to auditory and/or verbal stimulus
- pupils
Eye opening pediatric GCS 1, 2, 3, 4
4 - spontaneously
3- to speech
2 - to pain
1 - none
best motor response pediatric GCS 1,2, 3, 4, 5, 6
1 - none
2 - extension
3 - flexion abnormal
4 - flexion withdrawal
5 - localizes pain
6 - obeys commands
best auditory/verbal response > 2yearold GCS T, 1, 2, 3, 4 ,5
T - tracheal tube
1 - none
2 - incomprehensible words
3 - inappropriate words
4 - confused
5 - oriented
best auditory/verbal response < 2yearold GCS T, 1, 2, 3, 4 ,5
T - tracheal tube
1 - none
2 - agitated
3 - inappropriate persistent cry
4 - cries, consolable
5 - smiles, listens, follows
What is important to consider when utilizing GCS to assess pediatrics
o Heavily rely on parents because kids can ignore strangers and know differing cries, behaviour, etc
o Irritable does not necessarily mean CNS deficits; may not want to be around you
When do most post-traumatic seizures occur?
on impact or within 24 hours.
Early post traumatic seizure occurrence
1-7 days after injury
Late post traumatic seizure occurrence
> 1 week post injury
Early and late post-traumatic seizures are more frequently associated with ______________ and include what 4 things:
Visible cranial injury
o brain swelling
o subdural hematomas
o depressed skull fractures
o and lower GCS scores.
7 Complications of Severe Head Injury
- Ischemia insufficient blood flow
- Death of brain tissue due to hypoxia
- Motor/sensory deficits
- Hearing, vision
- Speech may be affected
- Learning disabilities
- Behavioral problems
What is an epidural hematoma?
Bleed between cranium and dura (protective outer membrane of brain
Usually caused by skull #
SUDDEN onset
What is a subdural hematoma?
Bleed directly against brain
SLOWER onset
What type of brain bleed has a slower onset?
subdural
When are signs of ICP present til in subdural hematoma?
until 24 hours – 2 weeks after injury
What are the leading cause of hospitalization and death for Canadian children and youth between the ages of 1 and 19 years.
Injuries
Unintentional Injury
falls, burns, drowning, motor vehicle incidents and other situations that are often referred to as “accidents.”
Intentional Injuries
acts of violence such as suicide attempts, rape and assault (physical or sexual)
What are the implications of the Sask Prevention Institutes Statement:
* “Unintentional injuries are not “accidents”; they are predictable and preventable.”
* “Often the appropriate injury prevention steps are not taken which results in devastating injuries.”
Places judgement on parents
What are the key messages for nurses regarding injuries of children?
- Not our role to judge parents regarding the “accident”
- It is our role to care for the entire family (both parents and child).
Fall Prevention
- safety measures dependent on child’s development
- adult should participate in active supervision
When can children cross the street safely by themselves and why?
until age 9
Reasons include:
– Mental/cognitive development/perception
– Height – might not be seen
– Sight
– Hearing – even if they hear, don’t recognize danger
Main poisoning hazards
- medicine
- vitamins
- plants
- cosmetics
- chemicals
Poisoning prevention
- Store poisonous substances in locked cabinets (not just stored up high).
- Call the Poison Centre in the case of a suspected poisoning
Roles of nurse in injury prevention
Encourage
- education for parents
- engineering
- environmental safety
- enforcement of policy
- evaluation using research
6 Nursing Diagnosis for Alterations to Neuro Function
- inadequate airway
- altered neuro function r/t increased ICP
- Pain r/t increased ICP
- Risk for ineffective tissue perfusion r/t increased ICP
- Potential for seizures r/t increased ICP
- Potential for FV deficit r/t increased ICP
7 Nursing Interventions r/t Alterations to Neurological Status
- Maintain patient airway
- Breathing – Oxygen
- Monitor neuro function using GCS
- Monitor fluid volume
- Monitor for seizures
- Maintain safe environment
- Pain medications
As ICP increases, _______ decreases and ________ become more pronounced
LOC
Signs and symptoms
TBI occurs when a head trauma results in
Disruption to normal function of the brain
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