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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

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