Head Injury/Test 3 Flashcards
(37 cards)
Head injury
*any trauma to scalp, skull or brain. Primarily signifies craniocerebral trauma, including an alteration in consciousness.
Poor outcomes of head injuries:
presence of an intracranial hematoma; increasing age of the patient; abnormal motor responses; impaired or absent eye movements or pupil light reflexes; early sustained hypotension, hyoxemia, or hypercapnia; ICP levels are higher than 20 mm Hg
Major head trauma: Contusion-
bruising of the brain tissue within a focal area. Develops areas of hemorrhage infarction necrosis and edema.
Contusion: Coup is
site of direct impact
Contusion: Countrecoup
(secondary) injury caused by movement of the brain inside the skull.
Laceration is
actual tearing of brain tissue and often occurs in association with depressed and compound fractures and penetrating injuries. Tissue damage is severe and surgical repair is impossible because of the texture of the brain tissue.
Delayed responses of laceration:
Hemorrhage, hematoma, formation, seizures and cerebral edema
Head Injury: Pathophysiology:
Widespread axonal damage occurring after a mild, moderate or severe TBI. Increasing evidence that axonal damage is not preceded by an immediate tearing of the axon from the traumatic impact, but rather the trauma changes the function of the axon, resulting in axon swelling and disconnection. Takes approximately 12-24 hours to develop and may persist longer.
S/S of head injury
- decreased LOC
- increased ICP
- decerebration or decortication
- global cerebral edema
Complications of head injury:
epidural hematoma (bleeding between the dura and inner surface of the skull; neuro emergency.
S/S of complications of head injury:
- Unconscious at the scene.
- HA
- N/V
- Focal findings
- Subdural hematoma (bleeding between duramater and arachnoid layer of menigeal covering of the brain.) usually venous in origin, slower to develop large enough to produce symptoms
Subdural hematoma: Acute
- 24-48 hr after severe trauma
- Immediate deterioration
- Craniotomy, evacuation and decompression
Subdural hematoma: Subacute
- 48 hr-2 week after severe trauma
- Pt will show lethargy and will only open eyes to shaking and loud voices calling their name.
- Initial unconsciousness, gradual improvement, deterioration over hrs, dilation of pupils and ptosis.
- Evacuation and decompression
Subdural hematoma: Chronic
- Weeks to months, ususally >20 days after injury; often injury seemed trivial or forgotten by patient
- Nonspecific, nonlocalizing progression; progressive alteration in LOC
- Evacuation & decompression, membranectomy
Scalp lacerations:
Most minor type of head trauma (many blood vessels with poor constrictive abilities)
Scalp lacerations: Major complication:
Infection
Skull fractures:
- Linear depression
- Simple
- Closed or open
Assessment for CSF leakage:
- Testing to determine if leakage is CSF:
- color
- appearance
- amount of leaking fluid must be noted because both of these tests can give false-positive results
Diagnostics for cerebral spinal fluid leakage (CSF);
- Dextrostix or Test-tape (positive for CSF leak)
* “lalo” or “ring” sing if the drainage is bloody, place on white dressing to see if there is a halo
Head injury: Minor head trauma
Concussion
Concussion:
a sudden transient mechanical head injury with disruption of neural activity and a change in LOC. May not lose total consciousness.
Post concussion syndrome:
Two weeks to two months post injury. Persistent headache, lethargy, personality and behavioral changes, shortened attention span, decreased short term memory, changes in intellectual ability. Can significantly affect patient’s abilities to perform activities.
Head injury: Major head trauma
- Contusion
* Laceratiion
Epidural Hematomas:
- bleeding between the dura and inner surface of the skull; neuro emergency depending on size
- a collection of blood between the skull and the dura
- commonly associated with temporal and parietal fractures
- S/S unconsciousness at the scene, headache, n/v, focal findings
