Week 4--NEURO --(MR. LIEB)

Question 1

TWO MECHANISMS OF INJURY WITH REGARD TO NEURO INJURIES

Answer 1

1. BLUNT TRAUMA
   
   1. mvc
   2. Falls
   3. Sports injuries
   4. Assault
2. PENETRATING INJURIES
   
   1. unintentional injuries
   2. firearms (ie, guns)

Question 2

Since NEURO injuries require ALOT OF FORCE to become injured…there are other “concurrent” injuries that nurses need to be mindful for.

Answer 2

1. CERVICAL SPINE INJURIES
   
   1. Must maintain inline cervical spine stabilization using C-Collar and safe pt transportation until injury has been cleared
2. VERTEBRAL COLUMN
3. FACIAL FRACTURES
4. EYE INJURIES
5. RESPIRATORY/AIRWAY COMPROMISE

Question 3

Primary vs Seconday Injuries

Answer 3

• Primary ^{<u>(this is the injury we cant change)</u>}
  
  • ​Neuronal destruction is permanent once neurons die
    
    • Direct transfer of energy leading to injury
    • Fractures, bleeds
• Secondary ^{(this outcome can be made better with good care management)}
  
  • ​Contains PENUMBRA (area surrounding dead area)
    
    • It is at risk for decreased oxygen, decreased glucose and could also die in addition to the already dead tissue
      
      • ​Region of impaired/ischemic tissue
      • It is viable and may be salvaged
        
        • Caused by pathophysiologic changes after primary injury which lead to:
          
          • Hypotension
          • Hyperthermia
          • Hypoxia
          • Cerebral edema
          • Increased intracranial pressure (ICP)

These changes can further damage vulnerable cells

Question 4

With PRIMARY INJURIES–Neuronal destructrion is permanent once neurons die

True or False

Answer 4

true

Question 5

SECONDARY INJURIES contain an area called _______________ that are found around the central core of dead neurons

Answer 5

PENUMBRA

Question 6

“4” types of FOCAL BRAIN INJURIES

Answer 6

1. EPIDURAL HEMATOMA
2. SUBDURAL HEMATOMA
3. CEREBRAL Contusion
4. Intracerebral Hematoma

Question 7

EPIDURAL HEMATOMA

Answer 7

1. 90 % occur as a fracture to temporal/parietal bone
2. Laceration of the middle meningeal artery (rapid accumulation of blood)
3. Bleeding between DURA and SKULL

ASSESSMENT

• TRANSCIENT loss of consciousness followed by LUCID period (acting normal)
• Unilateral fixed / dilated pupil
• Rapid Neuro decline

TREATMENT

• surgical intervention is required
• burr hole to lower ICP

Question 8

SUBDURAL HEMATOMA

Answer 8

1. Injury to “Bridging Veins” …BELOW THE DURA
2. Direct Injury to brain tissue

ACUTE

• S/S begin to appear within 48 hrs (2 days)
• Decreased Cerebral blood flow
• HIGH MORTALITY RATE 30-90%—(lower if surgery happens)

CHRONIC

• S/S may take 2 weeks (or more) to be symptomatic
• slow accumulation of blood

AT RISK POPULATION

• anticoagulant use
• older adults and chronic ETOH abuse (shrinks brain putting extra pressure on bridging veins causing them to break open

TREATMENT

• If SMALL……..Observe and allow body to reabsorb
• IF LARGE or Causing significant neuro s/s…..surgical evaluation

Question 9

DIFFERENCE

between

EPIDURAL HEMATOMA

AND

SUBDERMAL HERMATOMA

Answer 9

EPIDURAL = arterial blood SUBDURAL= Venous blood flow

• DURA is peeled back from skull DURA still attached to skull
• fractured bone

Question 10

CEREBRAL CONTUSION

Answer 10

• Bruising of the brain
• Capillaries are damaged
• Hemorrhage or Infarction

S/S will peak at 18-36 hours and they depend upon the size and location of contusion

INITIALLY, pt is often unconscious

Behavioral changes / irritability

motor or speech

Question 11

INTRACEREBRAL HEMATOMA

**similar to hemorrhagic shock

Answer 11

Occurs deep within the brain (Parenchyma)

May be associated with contusions

The hematoma compresses brain tissue- 2cm or greater causes great concern

ASSESSMENT

Decline in LOC as hematoma grows

TREATMENT

• IF SMALL—watch and wait if small or deep in the brain
  
  • REPEAT CT’S q 4 hours
• SURGICAL REMOVAL IF LARGE OR EASILY ACCESSIBLE

Question 12

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