NEURAL DISTURBANCE

HEAD INJURY

2/3 OF DEATH FROM VEHICULAR ACCIDENT PROMPT INTERVENTION MINIMIZES DEVLP OF 2O PROBLEMS TREATMENT OF HYPOXIA & ACID-BASE IMBALANCE DECREASES MORTALITY INTRACRANIAL MASS LESIONS MAY FOLLOW INITIAL TRAUMA SEVERE CEREBRAL SWELLING OFTEN FOLLOW BRAIN INJURY AEGS WITH H.I. OFTEN HAVE OTHER MAJOR INJURIES

MECHANISM OF HEAD INJURY

CAUSED BY SUDDEN FORCE

ACCELERATION DECELERATION DERFORMATION ROTATIONAL FORCE

CATEGORIES OF HEAD TRAUMA

BLUNT TRAUMA
Complex,

with several head structures

involved

PENETRATING
Depends

on the velocity of object (low velocity and high velocity) Infection (complication)

COUP INJURY COUNTRECOUP INJURY

NOTE: H.I. MAY ALSO BE CLASSIFIED AS PRIMARY AND

A.)PRIMARY HEAD INJURY SCALP INJURIES SKULL INJURIES BRAIN INJURIES

FOCAL

INJURY DIFFUSE INJURY

SCALP INJURY SUPERFICIAL ALONE IS MINOR COVER AND APPLY PRESSURE --- EXCEPT???

SKULL INJURIES

OFTEN WITH BRAIN INJURY CAUSES ABRASION AND LACERATION OF BRAIN TISSUE 3 TYPES:
no Tx needed DEPRESSED surgery BASILAR base of frontal and temporal lobes, diagnosis???
LINEAR

CLINICAL SIGNS

INTRACRANIAL CSF FISTULA

CSF

OR OTHER DRAINAGE FROM EAR OR NOSE

VARIOUS CRANIAL NERVE INJURIES BLOOD BEHIND THE EARDRUM PERIORBITAL ECCHYMOSIS BATTLES SIGN

BRUSIE

OVER THE MASTOID Mgt: DIAMOX, LUMBAR DRAIN, CRANIECTOMY, CRANIOPLASTY

BRAIN INJURY

FOCAL INJURY
SMALL

HEMORRHAGES OF THE CORTICAL SURFACES MAY CAUSE SECONDARY BRAIN DAMAGE

DIFFUSE INJURY
TEMPORARY

LOSS OF NEUROLOGIC FUNCTION WITHOUT STRUCTURAL DAMAGE

DIFFUSE AXONAL INJURY

SHEARING

OF AXONS IN THE W.M. IMMEDIATE COMATOSE & MAY NOT AWAKEN

B.) SECONDARY
HEMORRHAGE INFECTION SECONDARY BRAIN SWELLING AND EDEMA CAROTID ARTERY OCCLUSION

HEMORRHAGE
EPIDURAL, SUBDURAL, & INTRACEREBRAL A. EPIDURAL HEMATOMA (EXTRADURAL) - involves extracerebral blood vessels, middle meningeal artery and vein ASSESSMENT: - ACUTE MANIFESTATION? Classical Sign: 1. unconsciousness immediately after head trauma 2. Awakens & quite lucid Dx criteria 3. Later, lapses to come

CONSIDERED A MEDICAL EMERGENCY!

SUBDURAL HEMATOMA (SDH)

COLLECTION OF BLOOD BETWEEN DURA AND ARACHNOID BLOOD IS NOT REABSORBED BUT BECOMES ORGANIZED OR ENCAPSULATED BY THE DURA BLOOD CLOTS AND THEN LATER ON LYSES (HIGH OSMOTIC CHARACTER) --H2o fr. SAS --- increase ICP 3 categories: ACUTE & SUBACUTE and CHRONIC
= 24 48 hrs Subacute = 48 2 weeks Chronic = 3 weeks months
Acute

SDH MANIFESTATION

Acute & Subacute SDH

Changes in LOC Pupillary signs Hemiparesis

Chronic SHD
Seen freq. in the elderly Devlp from minor H.I. Person seems to recover, then, neurologic signs progressively develop HEADACHE prominent Symptom LOC most predominant assessment finding Focal or lateralizing symptom (hemiparesis)***

INTRACEREBRAL HEMATOMA
OCCUR LESS OFTEN THAN EPIDURAL OR SDH, AND CAUSE DIRECTLY BY BRAIN TISSUE BLEEDING ASSESSMENT FINDING SAME WITH EPIDURAL AND SDH hemiplegia more common than hemiparesis

Additional secondary head trauma

BRAIN SWELLING AND EDEMA

ASSOCIATED

WITH SERIOUS HEAD INJURIES

INFECTION
OPEN

HEAD INJURIES MENINGITIS AND BRAIN ABSCESS

Classification
Mild (GCS 13 to 15, with loss of consciousness to 15 minutes) Moderate (GCS 9 to 12, with loss of consciousness for up to 6 hours) Severe (GCS 3 to 8, with loss of consciousness greater than 6 hours)

Diagnostic Evaluation

CT scan to identify and localize lesions, edema, bleeding. Skull and cervical spine films to identify fracture, displacement. Neuropsychological tests during rehabilitation phase to determine cognitive deficits. CBC, coagulation profile, electrolyte levels, serum osmolarity, ABG values, and other laboratory tests to monitor for complications and guide treatment.

MANAGEMENT/ TREATMENT

EMERGENCY AND ACUTE CARE

AIRWAY 100 % OXYGEN MAINTENANCE OF CIRCULATION

MEASURES TO REDUCE ICP

CSF DRAINAGE
If disconnected, clamp nearest the head Check for leakage Avoid pressure or kinking Clamp drainage tubing when moving or turning the patient

OSMOTHERAPY
Dehydrate the brain; MANNITOL FBC!; I & O!; may be combined with fluid restrction

STEROIDS HYPERVENTILATION HYPOTHERMIA BARBITURATES Tx FOR OTHER COMPLICATION

HYPONATREMIA
FLUID

- < 130 Meq/L ????

RESTRICTION < 800 mL

HYPERNATREMIA

POLYURIA, sp. Gravity = 1.000 -

1.006 HYPERMETABOLIC STATE 1 2 yrs. Prophylactic meds POST-TRAUMATIC SEIZURE

NURSING INTERVENTION

MAINTAIN THE AIRWAY MAINTAINING FLUID AND ELECTROLYTE BALANCE POVIDING ADEQUATE NUTRITION PREVENTING INJURIES MONITOR BODY TEMPERATURE MAINTANING SKIN INTEGRITY
ASSESS AL BODY SURFACE Q 8HRS TURN Q 2 4 HRS PROVIDE SKIN CARE Q 4 HRS.

IMPROVE COGNITIVE FUNCTION PREVENTING SLEEP PATERN DISTURBANCE

PREVENTING INJURY

OBSERVE FOR RESTLESSNESS AVOID BLADDER DISTENTION PADDED SIDE RAILS, HANDS WRAPPED IN MITTS AVOID RESTRAINTS AS MUCH AS POSSIBLE AVOID USING NARCOTICS FOR RESTLESSNESS DECREASE ENVIROBNMENTAL STIMULI PROVIDE ADEQUATE LIGHTING TO PREVENT VISUAL HALLUCINATION