54 terms

Traumatic Brain Injury

Traumatic Brain Injury
Primary Head Injury
Actual impact to head
Secondary Injury
bodies response to primary head injury: inflammation, bleeding, hematomas. all cause squeezing on brain
decrease in cerebral perfusion and increased ICP
major effect of secondary injury
pain, hypercapnia, decrease O2, hypotenison
a squeezed brain
decreases in cerebral perfusion
most important NX care
maintaining oxygenation and cerebral perfusion
direct injury
acceleration and deceleration injuries. still and hit from behind, and moving head hits dashboard
indirect injury
jarred body transmits to the brain and it moves with in the skull across ridged edges , causes tearing and shearing of the brain and blood vessels
closed head injury
skull is intact no opening at all
open head injury
an exposure of intercranial contents to the external environment this can cause infection
rotation / tortion injury
brain spins around the skull on impact from acceleration or decleration. causes brain to become stretched and blood vessel stretch and can obstruct blood flow
penetrating injury
occurs when an object forcibly enters the cranial vault damaging the protective meningeal layers, cerebral blood vessels and brain tissue
deformation injuries
skull fracture, concussion, cerebral contusion or intracranial hemorrage. usually associeated with a blunt object striking the head or head hit dashboard
acceleration-deceleration injury
the brain rapidly accelerates and decelerates within the skull
acceleration injury
the heads velocity abruptly increases, causes the brain to strike the skull
deceleration injury
the heads velocity abruptly decreases causing the brain to strike the skull
contrecoup injury
occurs when the brain strikes the skull surface opposite the site of original impact
rotational acceleration-deceleration injury
forces that cause the brain to twist within the skull, resulting in torsion and shearing of brain tissue and possible vascular disruption
a minimal traumatic brain injury. no break in the dura and non penetrating and loss of consciencious does not last more than 6 hours
post concusive syndrome
cognitive changes from even a mild concussion must treat symptoms, can last for years
second impact syndrome
a second concussion that occurs while healing from first one can be lethal and deadly
grading concussions
mild is grade 1, loss of consciousness for 2 hours grade 5
A focal brain injury. causes specific injuries depending on which part of the brain is impacted and what that part controls
severe contusion
necrosis of the brain in the injured area and leaves neuro deficits to the part of the body controlled by the injured area
mild contusion
clears as bruising resolves and leaves no neuro deficits
cerebral laceration
tearing of the cortical surfaces followed by swelling and bleeding within the skull= a mass effect of a space occupying lesion
diffuse axonal injury
caused from deceleration and acceleration forces that shear and tear the axons (the messengers) damage to a wide spread area
coup injury
damage occurs at area of initial impact and is a deceleration injury
severe DAI
a coma greater than 6 hours can result in a persistant vegatative state
Hallmark signs of DAI
Hypertension, Hyperthermia, Hyperdrosis (sweating)
axon tracts
white matter, the neurons that allow communication to each other
Primary Brain Injury
brain injured at time of accident= contusion, laceration, hemorrage, hematoma
secondary brain injury
seizures, increased ICP, decrease cerebral perfusion
long term brain injuries
epilepsy, hydrocephalas, movement difficulties
diffuse brain injury
occurs through out he brain
crush, dai, coup/countercoup injuries
the brain stem is bruised and the brain tears
bullet type head injury
shock waves occur and create a cavity calles a wound tract. shock waves are 30-40 times the size of the bullet
basilar skull fractures
fractures of one or more of the 5 bones lovated at the base of the skull. will have a tear in the dura adjacent to the injury
lineal skull fractures
does not tear dura and will heal with out treatment
leakage of CSP
proves the dura is teared
comminuted fractures
many pieces of the skull are fracture and there are multiple linear fractures
depressed fractures
greater than the skull's thickness mush have sx to elevate the bone = a cranioplasty
5 bones in the base of the skull (basiular fractures)
frontal (forehead), temperal (both side), occipital (back lower portion), ethmoid (eye socket), sphenoid (above the cheek)
brain stem and vital organs resides
anterior fosse, posterior fosse, middle fosse (basicular bones form these hollow depressions)
NX care for basicular fractures
neuro cks, cardiac, respiratory , BP, antibiotics, steroids to decrease inflammation, lumbar puncture twice a day if they do not have increased intercranial pressure.
lumbar puncture
do it twice a day and remove 30 ml to dry the fluids and allow site to dry
edema on brain stem
could cause and MI
Pt teaching
do not blow nose or place anything in ear or nose
complication of basicular fractures
can cause corrided artery hemorrage , damage cranial nerves 3. 4 and 6 (eyes)
cranial nerve 3
effects pupil dilation
uncal herniation
dilated pupil on the side of injury
secondary injuries to watch out for
infection, hematoma, edema
can increase metabolic rate and the need for the brain to have more O2 (which would increase ICP from the vasodilation)
mannitol and hypertonic solutions
takes fluid from the intervasular cells and decreases ICP