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HCD III: Module C Intracranial Regulation Week 2 Part 2 (traumatic brain injuries)
Terms in this set (30)
Mechanical force to brain without penetration
Usually caused by deceleration, acceleration (coup-contrecoup) or rotational force or a combination of all
Missile or Penetrating Injuries
Caused by objects that penetrate the skull and produce a significant focal injury
The injury may be depressed, penetrating or perforating
Can be such things as a knife, bullet etc.
Perforating injuries: enter & exit the brain
High risk for infection & abscess. Often fragments embedded.
Outcomes are based on degree of penetration & location of injury
occurs at moment of impact
extent is related to the degree of injury, whether injury is localized or diffuse
This is the biochemical & cellular response to the initial trauma
It exacerbates the primary injury
Includes things like ischemia, hypercapnia, hypotension, edema,
Ischemia is primary culprit because of poor perfusion. Cells swell, vasodilatation occurs & ICP↑
Can be either open (dura torn) or closed
Depressed (mashed in)
__ (vault or base)
Basilar skull fracture: not always visible on films, Findings: __ in ear or nose, Battle sign (hematoma over mastoid) or __ eyes
A blow to the head causes one or more of the types. It may not be problematic unless the brain is exposed or __ fragments are driven into neural tissue.
Significance of fractures that it can indicate patients with a higher probability of developing a intracranial __
Brain injury with a brief loss of neurologic function
Characterized as a blow to the head hard enough to make the brain hit the skull but not hard enough to cause a cerebral contusion; causes temporary neural dysfunction
Most common is loss of consciousness
Can often be confused, disoriented, amnesia, c/o HA, nausea, irritability etc.
Bruising of the brain, usually related to acceleration-deceleration injury
The result is hemorrhage into the parenchyma often frontal or temporal lobes
affects the tissue directly under the point of impact
affects injury in a line directly opposite the point of impact
injury both directly & opposite injury
Diffuse Axonal Injuries
DAI is the most significant cause of morbidity in patients with traumatic brain injuries, which most commonly are the result of high-speed motor vehicle accidents
Diffuse axonal injury (DAI) is a frequent result of traumatic deceleration injuries and a frequent cause of persistent vegetative state in patients.
A wide range of brain dysfunction caused by acceleration/deceleration & rotational forces
Causes a loss of consciousness
Pathophysiology is related to stretching & tearing of axons as a result of movement of the brain inside a closed container
The result of these shearing forces in areas of greater density of the brain is trauma to the axons, which results in edema and leakage that is most severe during the first 2 weeks after injury
Bleeding which produces a space occupying lesion on the brain
blood between the skull & the outermost layer of the dura (bleeding above dura mater)
It's most common in 20- to 40-year-olds
Most result from arterial bleeding.
Blood commonly accumulates between skull and dura mater.
Injury to middle meningeal artery in parietotemporal area is most common and is typically accompanied by linear skull fractures in temporal region over middle meningeal artery.
It less commonly arises from dural venous sinuses.
Meningeal hemorrhage results from accumulation of blood in subdural space (between dura mater and arachnoid mater)
It may be acute, subacute, and chronic: unilateral or bilateral.
It's usually associated with torn connecting veins in cerebral cortex; rarely from arteries.
Large acute hamatomas are a surgical emergency.
Subacute hamatomas have better prognosis because they occur over a longer period of time.
bleeding within the cerebral tissue;
Traumatic or spontaneous disruption of cerebral vessels in brain parenchyma cause neurologic deficits, depending on site and amount of bleeding.
Shear forces from brain movement frequently cause vessel laceration and hemorrhage into the parenchyma.
Frontal and temporal lobes are common sites. Trauma is associated with few intracerebral hematomas; most are caused by hypertension.
Management of TBI:
If caused by hematoma than __ is indicated to evacuate hematoma
If caused by swelling than __ interventions are indicated
Goal of both therapies is to minimize damage and preserve brain function
For TBI, Want CPP> __
If ↑ you can reduce volume of one of more of the compartments Brain, CSF, or blood
CSF- with ventriculostomy can __ CSF fluid. This is done when ICP>20
Brain: can use __ to ↓swelling
Blood: can ↑BP which increases MAP to accommodate the ↑ICP
Hyperthermia increases cerebral metabolic rate while Hypothermia decreases cerebral metabolic rate so use: (2)
TBI: Pain Control & __ is a must
Consider barbituate coma
Consider neuromuscular blockade (paralytics)
Fluid volume maintenance: may use Isotonic or __ (3%NS) do not use Hypotonic
Pharmacology: Use of agents of ↑MAP. (2)
If BP>__ can worsen the edema so use of betablockers indicated. i.e. Labetalol etc. Still need to keep CPP > 70
Subarachnoid Hemorrhage (SAH)
SAH refers to the nontraumatic types of hemorrhages. Usually caused from rupture of a berry aneurysm or arteriovenous malformation (AVM).
Risk factors: hypertension, smoking, alcohol & stimulant use.
Causes of aneurysm:
Berry aneurysm: usually congenital;
Thinned vessel __;
in SAH can have positive __: meningeal irritation. Raise leg straight or flex thigh then extend. Abnormal if resistance & pain down posterior thigh
in SAH can have positive __: Meningeal irritation> Flex chin on chest, watch hips & knees. Resistance & pain in neck with flexion of hips & knees
Bleeding directly into cerebral tissue
Destroys brain tissue
Causes cerebral edema
Usually caused by small artery bleed
More than 2X as common as SAH with higher mortality & disability
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