Traumatic Brain Injury Flashcards
Primary Brain injury
Damage that occurs at the time of the injury
Secondary brain injury
Process that occurs after initial injury & worsens the patients outcome
What are open primary brain injuries?
Linear fracture
Depressed fracture
Open fracture
Comminuted fractured
Basilar fracture
What are closed primary brain injuries?
Concussion
Contusion
Diffuse axonal injury
Primary Closed brain injury
Skull integrity not violated
Brain damage occurs from blunt force
Open primary brain injury
Skull is fractured or pierced by penetrating object
Linear fracture
Clean break, impacted bone bends inward & surrounding area bends outward
Depressed fracture
Bone is pressed inward into the brain
Open fracture
Scalp/dura is lacerated, providing direct opening to brain
Comminuted fracture
Fragmented bone with depression into brain
Basilar fracture
Fracture of the floor of the skull
S/S: raccoon eyes, battles signs, bleeding from nose & ears, cerebral fluid from nose
CSF Test
• Glucose test - if it’s positive then it’s CSF
• Halo test - forms a halo on gauze with a bloody circle in middle & clear circle around bloody circle
Concussion
Brain trauma from blow to head or similar injury
Temporary loss of consciousness
Contusion
Bruising of the brain from blow/similar injury
Recovery depends on damage & edema
Damage at site & where brain bounces off skull
Diffuse axonal injury
Damage to axons in the white matter & tearing of vessels
What are secondary brain injuries?
Increased intracranial pressure
Hemmorrhage
Epidural
Subdural
Intra-cerebral
Brain herniation
Hemorrhage
Potentially life threatening
Act as a space occupying lesions that are surrounded by edema
Epidural (brain bleed)
• Arterial bleed into the space between the dura & inner skull
• Often caused by temporal bone fracture which ruptures an artery
• Fast bleed
• Brief loss of consciousness
• temporary period of improvement
• rapid deterioration
Subdural (brain bleed)
• venous bleed into space beneath the dura & above the arachnoid
• caused by tearing of veins
•slower bleed
• high mortality rate
Intra-cerebral (brain bleed)
• bleed into subcortical white matter
• caused by tearing of small arteries & veins
•edema inside brain
• inside pushing everything out
Brain herniation
• continued edema causes brain tissue to be squeezed & shift across or through structures it’s not intended to
• S/S: increased ICP, decreased neurological status
Assess for pupils to see if they are reactive & pupil size is equal
STAT CT
Assessment & Interventions : Spinal
•Treat all TBI patients as if they have a spinal injury until it’s ruled out
•C collar/spinal collar
•Spinal board -allows them to lay flat & move them without having to change position
• HOB flat
•Log roll them if you have to move them
Assessment: ABC
• the priority
•increase risk for respiratory failure for TBI pt’s
• monitor respiratory effort- pulse ox, arterial gas, deep? Shallow? Fast? Slow? Apnea?
Assessment: Neurological
• LOC - it’s the first thing to go when there’s an altered mental status
• decreased S/S: irritable, restlessness, disoriented
• orientation- name? DOB? Location? President? Year? Season?
• can they follow commands?
• GCS
• Pupils -PERRLA?
• Postering?
Diagnostics
MRI
CT
Interventions
• Intubation
•sedatives but use cautiously since they can mask neuro symptoms
•seizure precautions
•TPN, modify diet
•frequent reorientation & mental status checks every 2-4 hours
•restraints are a last resort
• repeat CT & MRI
Medication: Dexamethasone
• corticosteroid
•IV push
• alleviates cerebral edema
• check blood glucose
•monitor ICP
Medication: Fentanyl
• opioid anagelsic
• for pain
•drip
•titration
•SE: hypotension, bradycardia, respiratory depression, apnea
• stays in system for a while
Medication: Phenytoin
- Used for seizure precautions
- Anticonvulsants
- IV Push/ drip/infusion
- First 7 days to decrease seizure threshold
- Phenytoin levels should be from 10-20
- Monitor liver function test
- Run through filters since it crystallizes
