- tear of dura mater (membranes surround brain) = leak of CSF

Week 10 - Head Injuries Flashcards by Samantha Porteous

describe the continuum of head injuries

can be mild ex. concussion

- or sever ex. traumatic brain injury (TBI)

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what are examples of causes of head injuries (4

car accidents
falls
assaults
sports & recreation

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the presentation of head injuries depend on.. (2)

severity of injury

- location (frontal, occipital, parietal, basilar etc.)

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who are involved in the care of head injuries

neurosurgery physicians/team

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what diagnostics are used for head injuries

CT head

- Xray of the cervical spine (high risk of vertebral fracture)

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describe when head CT’s are done for head injuries

at time of arrival/injury

- repeat CT scan 48 hr later and compare

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what is a risk associated w head injuries

IICP

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describe the prognosis associated w head injuries

very high risk of death
either occurs immediately after injury (d/t damage of brain structures or hemorrhage)
2hr after injury (secondary to organ trauma)
if survive 2hr period, death usually does not occur until 3 weeks after event (d/t multiple organ failures)

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what is a basilar skull fracture

fracture that occurs at the base of the skull

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what are 2 signs of a basilar skull fracture

battle sign

- raccoon eyes

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what is the battle sign

post auricular ecchymosis

- bruising around the ear

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what is the racoon eyes sign

bilateral periorbital ecchymosis

- bruising around the eyes

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what influences the clinical manifestations of skull fractures

location of the skull fracture

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if the pt is awake with a skull fracture, what are common compliants by the pt? (4)

tinnitus
poor hearing
vertigo
facial paralysis

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what is a complication of facial and skull fractures

dural tear ) CSF leak)

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what is a dural tear

tear of dura mater (membranes surround brain) = leak of CSF

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what is it called when CSF leaks through the ear

ottorhea

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what is it called when CSF leaks through the nose

rhinorrhea

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what is a risk associated with a dural tear (and therefore a facial and skull fracture)

meningitis risk

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what safety concern is associated w skull fractures

risk of NG tube insertion going into the brain

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what are ways to determine if nasal drainage is mucus or CSF

halo sign

- dextrose stirp test

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describe the halo sign to determine if leakage is CSF

soak exudate w 4x4
watch for a few min to see if halo appears
blood will be in the center, with the CSF creating a halo around

describe the dextrose strip test to determine if nasal drainage is CSF

CSF = rich in sugar
mucus = no sugar
use a strip test to see if has glucose or not

note: blood also rich in sugar, therefore if blood is in the drainage may get a false positive

what is a focal head injury

head injury that occurs in a specific area ( not diffuse bleeding all over)
bruising of brain tissue within a focal area

what signs are seen w a focal head injury (3)

- focal signs - but can lead to overall IICP - seizures common

what is the prognosis of a focal head injury

- depends on severity of contusion & whether it continues to evolve

what diagnostic is used for focal head injuries

- CT scan (can detect the extent of bleeding)

what is a contre-coup injury

- an injury that occurs both at the site of trauma and the opposite side of the brain from the force of the impact - leads to multiple contusions

what are priorities with a focal head injury (3)

- CT - monitor for IICP - no treatment to stop brain bleeds

what is a diffuse axonal injury

- widespread axonal damage that occurs after a TBI | - shearing of neurons --> axons swell and disconnect d/t trauma

describe the severity of DAI

- can be mild (concussion) | - or severe

describe the recovery of a pt with severe DAI

- 90% remain in a vegetative state

at what point after a TBI does DAI occur

- 12-24 hrs after initial TBI

what does DAI result in (3)

- global cerebral edema - IICP - decerebrate posturing

what is a complication of a head injury

- hemorrhage

what are two types of hemorrhage that can occur as a complication of head injury

- epidural hematoma = emergent | - subdural hematoma

what is an epidural hematoma

- bleeding between the dura and skull

describe the severity of an epidural hematoma

- emergency | - usually arterial = bleeds fast = ICP increases fast

what is the treatment for an epidural hematoma

- immediate surgery to remove the bleed

what is included in nursing care for an epidural hematoma (2)

- nursing care for IICP | - will have a monitor and drain in place

what is a subdural hematoma

- bleeding that occurs between the dura and arachnoid space

a subdural hematoma is usually... what does this mean

- venous = less urgent

what is an acute subdural hematoma? subacute? chronic?

- acute = up to 48 h after TBI - subacute = within 48h to 2 weeks after TBI - chronic (weeks or months after injury)

what is the treatment for subdural hematoma

- surgery to remove bleed

what is the nursing care for subdural hematoma

- nursing care for IICP`

what are the overall goals of head injury nursing mngmt (4)

- maintain adequate cerebral perfusion - remain normothermic - be free from pain, discomfort, and infection - attain maximal cognitive motor & sensory function

what are key nursing assessments for head injuries (3)

- monitor changes in LOC and neuro status --> sometimes q2min - halo test for CSF leak - treat IICP

what are initial, at the scene, emergency mngmt interventions (6)

- calm, gentle approach - patent airway - stabilize cervical spine until xray - apply pressure to external bleeding - warm blankets - assess for rhinorrhea, otorrhea, scalp wounds

what are emergency mngmt interventions once the pt has access to the hospital (11)

- O2 via NP or re-breath mask - establish 2 large bore IVs - keep warm - frequent neuro VS checks - ongoing monitoring of VS, O2 sats, cardiac rhythm, GCS, pupils, limb strength - support pt & family - watch for pain & infection - if pt off baseline, CT - support other organ systems - meds - prep for surgery if needed

what meds are used during emergency interventions for a pt w a head injury once at the hospital (3)

- pain meds - prevent seizures - drugs to decrease ICP and increase CPP

describe fluid admin in a pt w head injury

- give cautiously

describe ways to keep a pt w a head injury warm (3)

- IV fluids - warming lights - warm blankets

what is included in frequent VS neuro checks for a pt w head injury (2)