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Module 7 > Traumatic Brain Injury > Flashcards

Traumatic Brain Injury Flashcards

1
Q

Skull has 3 essential components

A

Brain tissue, blood and cerebrospinal fluid

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2
Q

Primary injury

A

Injury from car crash or impact
Happens then and there

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3
Q

Secondary injury

A

Will come from swelling , hypoxia , hypotension , etc

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4
Q

Monro-Kellie doctrine

A

When the volume of something in our head goes up .. the volume of something else has to go down

The head stays at 100 %

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5
Q

Which volume in the skull goes down first

A

CSF
It can be displaced into one of the cisterns in the head and even stop manufacturing

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6
Q

Next thing in the skull that would go down

A

Blood supply in the brain
It can’t be pushed anywhere and then the vessels will be compressed and the blood is not going to circulate
Once this happens then the pt starts becoming hypoxic leading to ischemia

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7
Q

Last thing that goes up in the skull

A

The brain tissue swells up leading to herniation

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8
Q

Cerebral blood flow is

A

Amount of blood in mL passing through 100 g brain tissue in 1 minute

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9
Q

Autoregulation of cerebral blood flow

A

So we can have a consistent amount of blood in the brain

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10
Q

MAP goal

A

At least 65 preferably 70

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11
Q

Map of greater than or equal to 150

A

Causes all of the autoregulation to shut down in the brain
Vessels lose their elasticity

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12
Q

Normal ICP

A

5-15 mmhg

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13
Q

Sustained intracranial of 20 or greater

A

Considered abnormal and must be treated

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14
Q

What happens when the brain loses its autoregulation

A

We can drain the pt head

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15
Q

CPP

A

Map- ICP

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16
Q

MAP formula

A

Systolic +diastolic x2 / 3

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17
Q

Why is diastolic pressure multiplied by two

A

The diastolic pressure last longer than my systolic

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18
Q

Normal ICP

A

5-15 mmhg

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19
Q

When do people posture?

A

If we go in and mess with them but they may be posturing the whole time

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20
Q

ICP increase .. Cushing triad

A

Systolic BP increase
Decrease pulshe
Altered resp pattern (kussmauhs , Cheyenne strokes, etc)

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21
Q

Indicated increased intracranial pressure (question in class)

A

Headache
Vomiting
Posturing
Pupillary changes’

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22
Q

Cushing triad ICP

A

Increased systolic BP
Decrease pulse
Decrease resp

Neuro issue

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23
Q

How do we support brain function in increased ICP

A

providing o2

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24
Q

Why is nutritional support important during increase ICP

A

The body needs more calories becuase it uses so many to heal .. we also do not want the gi to release endotoxins..

Even if it is just a trickle feed

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25
Death occurs at three point in time after injury. When is this?
Immediately after injury Within 2 hours after injury 3 weeks after injury
26
People who have multiple concussions such as football players and boxers..what do they lose?
Their language skills
27
Skull fractures
Linear or depressed Simple , communituted or compound Closed or open
28
Diffuse injury
Concussion Diffuse atonal injury
29
Focal injury
Lacerations Contusion Coup -contrecoup
30
Contusion
Bruise
31
Diffuse axonal injury
Widespread damage of brain Unconscious and unresponsive Jello consistency
32
A pt falls 10 ft and has a basilar skull fracture.. what is our major concern?
If this break tore the dura and have a meningeal leak (CSF) which could set them up for a big infection
33
Epidural hematoma
Medical emergency bleeding inbetween the dura and the skull Typically an arterial bleed ( fast) Comes from the middle meningeal artery O.R ASAPPPPPPP!!!!!!!! Faster in the O.R it dramatically changes their outcome
34
Classic signs of epidural hematoma
Walking dead Brief onset of unconsciousness at the scene Immediately after it happen Followed by a lucid period of consciousness then knocked out again
35
Acute Subdural hematoma
Similar signs and symptoms to compression in increased ICP Don’t go to the OR .. they wait a moment to see if they’ll seal them selves up and reabsorb Venous blood (much slower) ( breaching veins in the head)
36
Subacute subdural
After initial bleeding, may appear to enlarge over time When they go in for 2nd CT or MRI it will look bigger than what they came in then we will have to do something S/s of increase ICP
37
Chronic subdural
Peak incidence in sixth and seventh decades of life ( alcoholics at risk, elderly people)
38
Intracerebral hemorrhage
Bleeding in the parechyma Treat pt symptomatically and let the blood reabsorb The outcome depends on how bad the bleed was
39
Subarachoid hemorrhage
Present in the ER with a headache Sometimes mistaken as a migraine So dont shew off s/s because it “might “ be a migraine.. Bleeding into the subarachnoid space
40
What causes a subarachnoid hemorrhage
Uncontrolled hypertension , trauma, uncontrolled BP
41
Vasospasm
In about 3-14 days is when a pt can have a vasospasm in head after original bleed Dangerous and can cause hypoxia leading to ischemia leading to permanent damage =cell death
42
Treatment for vasospasm
Make them hypervolemic Let them be permissibly hypertensive Nimodipine(calcium channel blocker )
43
Battle signs from head injury
Periorbital edema and ecchymoisis Rhinorrhea Ottorhea Postaurcular ecchymosis
44
CSF
Very sticky and sweet
45
If CSF if dripping from nose and ears
Grab a gauze pad and let it drip on .. change it when needed Never pack ears or nose because we dont want it trapped anywhere besides the dura and we run the risk of it becoming infected
46
Why do we question an NG tube with head injury
Because it scoots up and down the nose and runs the risk of meningitis And document that you questioned the order
47
GCS
Best eye response Best verbal response Best motor response
48
When we need to do a neuro assessment and the pt is sedated .. what do we do
Let the physician tell you to bring them up from sedation to do neuro assessment
49
What is important to remember in GCS
To quantify what the pt can do in their limit like if they can only squeeze your hand they obey command but quantify it
50
If a person is intubated but can write you notes
Oriented ..but writes note Non verbal but wrote a note QUANTIFY
51
When giving report what is important to keep in mind when going over GCS
Do it at bed side with new nurse so she knows what ur looking at Take into consideration what the pt family saw when you weren’t in the room
52
Nerve I
Olfaction Test using an alcohol pad
53
Nerve II
Vision Test with a vision chart
54
Nerve III
Most eye muscles “Follow the moving finger” Some ICP can’t .. have odd eye movement
55
What if someone can’t see
Verbalize where things are.. put them in the same spot .. tell them when you move something
56
How we monitor ICP
Epidural Intraparenchymal Subarachnoid Ventricular
57
Gold standard monitoring for ICP
Ventricular Goes in into the drainage pressure into the brain
58
How are we going to monitor drainage system with ICP
Maintain temp control and watch for infection- watch labs, hot , flushed , running fever , maintain sterility
59
How to keep sterility safe with drainage system
Biopatch and dressing over
60
How can we support brain oxygenation w increase ICP
Oxygenation pao2 100%
61
Interprofessional care increase ICP
Identify and treat the underlying cause Support brain function Drug therapy Nutrition therapy
62
What can someone with a concussion tell us
Everything but not about the accident
63
Biggest concern of basilar skull fracture
Leak in meningeal , CSF leak, leading to a major infection
64
What vessel bled for pt to have a subdurral
Bridging veins
65
What. Is a GCS looking at
The best a pt can do

Module 7 (24 decks)

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