Traumatic Brain Injury Flashcards
What are the Mechanisms of Injury
Acceleration/Deceleration
Rotational
Penetrating
Contrecoup
What are the types of Fractures?
Linear
Depressed
Open
Basilar
What is Basilar Sign?
Battle sign (Behind ear)
Racoon Eyes
Otorrhea (CSF in ears)
Rhinorrhea (CSF in nose)
Positive halo signs (fluid on gauze, if turns yellow, CSF present)
What are the 3 points that increases Intracranial Pressure?
- Increased Blood volume (tumours/edema) - Increased bleeding that occupies space, decreases cerebral perfusion
- Increased Cerebral Blood Volume Dilution occurs which CPP less than 50 - auto regulation fails
- Increased Cerebrospinal Fluid (CSF) = Increased ICP, flow blocked = absorption decreased
What is Focal Brain Injury?
Local injury, range from small contusion to severe hematoma
[Focal Brain Injury]
What are the 3 types of Subdural Hematoma?
- Blood between dura and arachnoid
Acute: manifest <48hrs after (drowsy/coma, progress rapidly, unilateral h/a)
Subacute: manifests 48hrs-2wks, h/a, drowsy, contralateral hemiparesis
Chronic: over course of weeks, h/a, absent minded
[Focal Brain Injury]
Subdural Hematoma Interventions and Nursing Care?
Those that bleed more easily: alcoholics, anticoag users
Interventions: Surgical removal, drain
Nursing: LOC, and focused neuro assessment
[Focal Brain Injury]
What is Epidural Hematoma?
s/s & Interventions?
- Blood between dura and skull
S/s: Fixed and dilated pupils on ipsilateral side
I: Surgical removal, ICP monitoring, osmotic diuresis (to decrease ICP), airway protection, and mechanical ventilation
[Focal Brain Injury]
What is intraparenchymal Hematoma?
s/s? Interventions?
- Blood in brain tissue
S/s: h/a, decreased LOC, pupil dilation, contralateral hemiplegia
I: No surgical evacuation, treat ICP, management of CPP
(MAP-ICP)
What is Contusion?
Bruising of cerebral soft tissue
What is Diffuse Brain Injury? (3 parts)
Widespread involvement of the brain, difficult to detect and treat
- Concussion (mild TBI but blunt trauma)
- Diffuse axonal injury (shear force disrupts structure of neurons by vessels)
- Subarachnoid Hemorrhage (blood between arachnoid & pia mater – from ruptured cerebral aneurysm l/t uncontrolled HTN)
S/s of DAI? Subarachnoid? and Concussion?
DAI: Decreased LOC, Increased ICP, decerebrate or decorticate posture, cerebral edema
Subarachnoid: thunderclap h/a, contralateral hemiplaegia, pupil dilation
Concussion: [Rest, tylenol] Post-Concussion - h/a, short term memory loss, decreased concentration, fatigue, difficulty sleep, irritable, sensitive to light and noise
What are the Assessments?
- ABCs
- V/s
- Neuro assessments (LOC, motor function, Pupillary response, GCS)
- Secondary assessment (mech of injury, past mx hx, allergies, sx, comorbidities)
What is the 3 levels for severity of Injury?
- Mild TBI (GCS 13-15 with or w/o loss of LOC for 6 hrs)
- Moderate TBI (GCS 9-12 w loss of LOCL for 6 weeks)
- Severe TBI (GCS <= 8 on initial assessment or deterioration after 48 hours)
What are the diagnostics? (Lab, Imaging, Other)
Lab: ABGs, CBC, Coag, electro, BUN, CR, Liver, Osmolarity, u/a, urine osmolarity, drug toxicity
Imaging: CT Scan, MRI
Other: Tomography, transcranial doppler, EEG
