Traumatic Brain Injury Flashcards
Intracranial Fluid
10% CSF, 12% blood and 78% brain tissue that makes up 1.9L and does not alter the volume
Cerebral Blood Flow
requires 750-1000mL of blood due to the inability to store glucose and O2 but high demands for them.
Deficits in Cerebral Blood FLow Markers
<50 cerebral ischemia and >1500 is max constriction and intracranial hypertension occurs
Mean Arterial Pressure MAP
systolic BP + 2(diastolic BP)/3
ABG Levels in the Brain
High CO2 (>45mmHG) or low O2 (<50mmHG) relaxes smooth muscles, dilated cerebral arteries, and decreased cerebral vascular resistance Low O2 severe (<35mmHG) leads to anaerobic metabolism, lactic acid accumulation, high H+ concentration, low pH, increased cerebral vascular resistance, and vasodilation when autoregulation is lost
Cerebral Perfusion Pressure
the pressure needed to ensure brain functioning, MAP + ICP
Intracranial Pressure ICP
balance of components in the brain, one goes screwy, the rest compensate. typical levels are 5-15mmHG, >20mmHG is brain damage
Factors that Influence ICP
cardiovascular diseases BP intra-ab and intrathoracic pressure body position temp ABGs, mostly CO2 intrinsic mechanisms that control ICP
Monro-Kellie Doctrine
state of dynamic equilibrium where the one component goes screwy, the rest compensate and fix their mess
Pressure-Volume Curve/Relationship
Stage I is intracranial compartments increase in volume, throwing off the others, autoregulation is intact
Stage II is compliance beginning to be exhausted, increased of high ICP if there are no changes
Stage III comp mechanisms are exhausted and start to exhibit the mild S&S
Stage IV we be fucked, at risk for hypoperfusion, herniation, and death, where there is a stroke occurring
Herniation
brain tissue is forcibly shifted from the compartment of greater pressure to = the pressure gradient
Brain Injury
any trauma to the skull, scalp and brain that includes an alteration in LOC, no matter how brief
Primary Brain Injury
the initial time of injury that results in displacement, bruising and damage of the three components of the skull
Secondary Brain Injury
hypoxia, ischemia, hypotension, hypertension, edema or increased OCP that occurs from a primary injury later on
Scalp Lacerations
minor brain injury. Don’t be alarmed if it bleeds a lot, that is just how it be
Linear Skull Fracture
break in the continuity of bone without alteration of the relationship of parts and not in little pieces
Depressed Skull Fracture
dent in skull inward
Simple Skull Fracture
linear or depressed without fragmentation or communicating lacerations
Compound Skull Fracture
depressed and scalp laceration that has a communicating pathway to the intracranial cavity
Commuted Skull Fracture
linear or depressed fractures with the fragmentation of bone
Cerebral Edema
increase of fluid in the brain that can have many causes
Cytotoxic Cerebral Edema
local disruption of the function and or makeup of the cell membranes within the brain that comes from the destructive lesions or trauma to the brain resulting in cerebral hypoxia or anoxia, Na+ depletion. Impairs sodium-potassium pump
Vasogenic Cerebral Edema
changes in the endothelial lining of cerebral capillaries that cause macromolecules to leak from capillaries to the surrounding ECF space. Osmotic gradient off and increases the permeability of the blood-brain barrier
Interstitial Cerebral Edema
result of periventricular diffusion of ventricular CSF in a pt with uncontrolled hydrocephalus
S&S of Cerebral Edema
altered LOC confusion restlessness unilateral pupil change altered resp pattern or resp depression unilateral hemiparesis stupor abnormal motor response bilaterally fixed and dilated pupils are terminal stage coma resp arrest focal findings papilledema equilibrium be gone or diminished seizures headaches hypertension with widened pulse pressure hyperthermia poor and stiff posture
TX of Cerebral Edema
neuro exam ABCs suction to remove excess fluids O2 mannitol or hyeprtonic saline IV push or bolus electrolyte balancing corticosteroids, sedatives, and hypothermic therapy NG tube to prevent ab distension and NPO body positioning slow ambulating implementing falls safety procedures and seizure precautions nutritional support
Complications of Cerebral Edema
inadequate cerebral perfusion cerebral herniation cingulate herniation or lateral displacement of brain tissues beneath the falx cerbri tentorial herniation herniation of cerebral tonsils death coma
Diagnostic for Cerebral Edema
MRI CT MRA ECG ICP measurement conventional cerebral angiography brain tissue oxygenation transcranial doppler studies
Concussion
we been know, banging the brian around the skull, post-concussion is 2 weeks to 2 months post initial injury permitting that no symptoms occur
Chronic Traumatic Encephalopathy
term for degeneration in the brain due to repeated concussions or traumatic brain injury need more research about the effects
Diffuse Axonal Injury
axonal damage after traumatic brain injury mostly around the white matter decreased LOC, increased OCP, decerebration and global cerebral edema that can cause a vegetative state
Focal Injury
a localized area of injury that consists of laceration, contusions, hematoma, and cranial nerve injuries with serious nerve damage, may require surgery to correct the necrotic brain tissue
Contusion
bruising of brain tissues within a focal area
Epidural Hematoma
collection of blood resulting from the bleeding between the dura and inner surface of the skull that compresses the brain that is a neuro emergency
Subdural Hematoma
Collection of blood that results from bleeding between the dura and the arachnoid layer of the meningeal covering the brain
Intraparenchymal Hematoma
collection of the blood within the parenchyma that results in bleeding within the brain tissue that makes up 16% of brain injuries
Traumatic Subarachnoid Hemorrhage
traumatic injury forces damage to the superficial vascular structure in the subarachnoid space that causes vasospasm and diminished CBF that causes bleeding
Brain Tumour
occurs in the brain and spinal cord that can be primary or secondary, resulting from metastasis from a malignant neoplasm somewhere else in the body
Glasgow Coma Scale
useful in brian injuries, assess LOC through eye openings, reflexes, responsiveness to commands, ability to speak, verbal responses, reflexes to painful stimuli and motor funciton
