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Critical Care > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

Primary Brain injury

A

Damage that occurs at the time of the injury

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2
Q

Secondary brain injury

A

Process that occurs after initial injury & worsens the patients outcome

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3
Q

What are open primary brain injuries?

A

Linear fracture
Depressed fracture
Open fracture
Comminuted fractured
Basilar fracture

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4
Q

What are closed primary brain injuries?

A

Concussion
Contusion
Diffuse axonal injury

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5
Q

Primary Closed brain injury

A

Skull integrity not violated
Brain damage occurs from blunt force

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6
Q

Open primary brain injury

A

Skull is fractured or pierced by penetrating object

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7
Q

Linear fracture

A

Clean break, impacted bone bends inward & surrounding area bends outward

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8
Q

Depressed fracture

A

Bone is pressed inward into the brain

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9
Q

Open fracture

A

Scalp/dura is lacerated, providing direct opening to brain

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10
Q

Comminuted fracture

A

Fragmented bone with depression into brain

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11
Q

Basilar fracture

A

Fracture of the floor of the skull
S/S: raccoon eyes, battles signs, bleeding from nose & ears, cerebral fluid from nose

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12
Q

CSF Test

A

• 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

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13
Q

Concussion

A

Brain trauma from blow to head or similar injury

Temporary loss of consciousness

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14
Q

Contusion

A

Bruising of the brain from blow/similar injury

Recovery depends on damage & edema

Damage at site & where brain bounces off skull

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15
Q

Diffuse axonal injury

A

Damage to axons in the white matter & tearing of vessels

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16
Q

What are secondary brain injuries?

A

Increased intracranial pressure
Hemmorrhage
Epidural
Subdural
Intra-cerebral
Brain herniation

17
Q

Hemorrhage

A

Potentially life threatening

Act as a space occupying lesions that are surrounded by edema

18
Q

Epidural (brain bleed)

A

• 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

19
Q

Subdural (brain bleed)

A

• venous bleed into space beneath the dura & above the arachnoid
• caused by tearing of veins
•slower bleed
• high mortality rate

20
Q

Intra-cerebral (brain bleed)

A

• bleed into subcortical white matter
• caused by tearing of small arteries & veins
•edema inside brain
• inside pushing everything out

21
Q

Brain herniation

A

• 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

22
Q

Assessment & Interventions : Spinal

A

•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

23
Q

Assessment: ABC

A

• the priority
•increase risk for respiratory failure for TBI pt’s
• monitor respiratory effort- pulse ox, arterial gas, deep? Shallow? Fast? Slow? Apnea?

24
Q

Assessment: Neurological

A

• 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?

25
Q

Diagnostics

A

MRI
CT

26
Q

Interventions

A

• 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

27
Q

Medication: Dexamethasone

A

• corticosteroid
•IV push
• alleviates cerebral edema
• check blood glucose
•monitor ICP

28
Q

Medication: Fentanyl

A

• opioid anagelsic
• for pain
•drip
•titration
•SE: hypotension, bradycardia, respiratory depression, apnea
• stays in system for a while

29
Q

Medication: Phenytoin

A
  • 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

Critical Care (3 decks)

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