Neuro: Traumatic Injury Flashcards
(92 cards)
1
Q
Neurological Assessment
A
cornerstone of trauma care
basis for resuscitation efforts
tests nasal/ear drainage (halo sign) = basilar skull fracture
2
Q
ABCDE Approach
A
airway breathing circulation disability exposure/envirnment
3
Q
Disability Survey
A
glasgow coma scale
4
Q
ABC Assessment
A
airway (skin color, capillary refill, oxygen saturation) cervical spine examination severe bleeding stopped breathing assessed/managed circulation assessed/managed
5
Q
Opening an airway
A
maintain cervical spine stability
avoid hyperextending neck
assess for cervical stenosis or osteoarthritis
6
Q
spinal cord injury
A
anaerobic glycollysis atp depletion increased intracellular calcium arachidonic acid cascade potassium depletion spinal cord cellular death (ascending up)
7
Q
Chest Trauma
Pediatric
Pregnant Women
Older Adults
A
varied breathing patterns, diaphragmatic breathers
increased normal tidal bolume, increased respiratory rate, decreased residual volume & functional residual capacity
less pliable lung tissue, reduced pulmonary compliance
8
Q
Injuries to pleura
A
pneumothorax (collapsed lung, can lead to hemothorax)
9
Q
Hemothorax
A
blood accumulates in pleural cavity
type of pleural cavity
10
Q
Bleeding/Shock
A
compromises perfusion/oxygenation
at risk for hypovolemic shock
class IV shock = unsurvivable
death isn’t always immediate, secondary trauma causes organ failure
11
Q
Bleeding/Shock II
A
look for uncontrolled sources of bleeding
stop all external bleeding
treat hypovolemia
12
Q
Head Trauma/Acute Brain Injury Primary vs Secondary
A
brain initially injured on impact
injured brain cells swell/reduce blood supply to cells
causes secondary brain death
13
Q
Monro-Kellie hypothesis
A
brain resides inside fixed skull/contents are constant
14
Q
Brain conditions caused by trauma
A
basilar skull fractures brain herniations cerebral contusion coup-contrecoup injury brain hemorrage
15
Q
cerebral perfusion causes
A
decreased ATP production
depletion of cellular energy
cellular death
16
Q
Exposure assessment
A
all areas of body
look for hidden bruises/lacerations/impaled objects/bullet wounds/bleeding/open fractures
17
Q
Envinment TX
A
controlled avoid hypothermia continuous temperature monitoring warm blankets warm fluids
18
Q
unilateral dilated pupil
A
one dilated, one small
CNIII compression
19
Q
bilateral fixed, dilated pupils
A
pupils are stuck dilated
brain herniation
20
Q
Positive Babinski
A
great toe extends upward and fan out
abnormal
damage to spinal cord thoracic or lumbar
anoxic brain injury or tumor
21
Q
Aphasia types
A
Broca (expressive) sparse and nonfluent but preserved comprehension
Wenicke (receptive) fluent and voluminous but comprehension greatly diminished)
22
Q
Unconscious Patient Causes
A
head trauma cerebral toxins shock hemorrhage tumor infection (meningitis)
23
Q
Unconscious Patient Assessment
A
unresponsive
primitive/no response to painful stimuli
altered respirations
decreased cranial nerve/reflex activity
posturing (decorticate, decerebrate, flaccid)
bilateral, dilated, fixed pupils
pinpoint pupils (pons damage/druge overdose)
24
Q
Unconscious Patient DX
A
CT
MRI
Lumbar Puncture (needle inserted into subarachnoid space, sample of CSF for suspected meningitis, contra for increased ICP could lead to herniation of brain)
cerebral/arterial angiography (Ids vascular malformations w/ contrast dye through femoral artery)
EEG
Caloric Testing (dx brainstem/cerebellar lesions, cool water infused into ear)
25
Unconscious Patient Interventions
patency of airway
keep emergency equipment ready
monitor BP, pulse, heart sounds, respirations, pulse ox
assess body temp (increased could be hypothalamus/brainstem issue, increased metabolic rate of brain, or infection)
assess reflexes (cranial, cough, gag, corneal blink)
assess autonomic system (SNS/PNS)
monitor I/O
maintain nutrition (IV/enteral)
provide range of motion to prevent contractures
26
Intracranial Pressure Normal/Monitoring
5-15 mmHg
| monitoring is invasive
27
Intracranial Pressure Assessment
```
altered LOC
pupillary changes
fever
headache
nausea
vomiting
abnormal respirations
elevated SBP
widened pulse pressure
bradycardia
Late: positive babinski, decorticate/decerebrate, seizures
```
28
ICP Interventions
```
management of underlying causes
adequate airway
avoid increasing intra pressure (straining/coughing/deep breathing/incentive spirometry)
head of bed to 30-40 degrees
avoid flexion of neck/hops
no bright lights
limit visitors
quiet nonstimulating environment
keep close to patient
ventriculoperitoneal shunt
```
29
ICP Meds
```
anticonvulsants (increase ICP)
Antipyretics/Muscle Relaxants (decrease ICP)
Blood pressure meds
corticosteroids
IV fluids
Hyperosmotic agents (mannitol)
```
30
Head Trauma Immediate Complications
```
cerebral bleeding
hematomas
uncontrolled increased ICP
infections
seizures
```
31
Head Injuries Long Term
changes in personality and behavior
| CN deficits
32
Types of Head Injuries
open: scalp lacerations, fractures in skull, interruption of dura mater
closed: concussions, contusions (bruising of brain tissue), fractures
33
Hematoma
collection of blood in tissues as a result of subarachnoid hemorrage
34
Concussion signs
brief disruption in LOC
amnesia regarding event (retrograde amnesia)
headache
35
Concussion serious s/s
```
worsening headaches
vomiting
excessive sleep/confusion
visual changes
weakness/numbness
```
36
Concussion Reccomendations
don't participate in strenuous or athletic activities min 1-2 days
rest/light diet
observed closely
37
Diffuse Axonal Injury
extensive tearing of nerve tissue throughout brain
tearing disrupts brain's regular communication/chemical processes
result of acceleration/deceleration motion (not really impact)
axons are stretched & damaged when parts of brain of differing density slide over one another
major cause of unconsciousness & persistent vegetative state after head trauma
38
Diffuse Axonal Injury DX
difficult to detect (not really present on injury)
| suspected in pts w/ normal CT scans but still unconscious
39
Diffuse Axonal Injury Tx/Prognosis
lacks a specific TX
| varies depending on damage
40
Coup-Contreoup
head strikes an object, brain injured under area of impact (coup), brain rebounds to opposite side of skull, second injury (contrecoup
common in motor vehicle accidents/shaken brain syndrome
usually frontal/occipital lobes (executive fx, memory, speech, motor skills, vision)
41
Epidural Hematomas
most serious
forms rapidly
result of arterial bleed
forms between dura/skull from tear in meningeal artery
associated w/ temp loss of consciousness then lucid then progress to coma
surgical emrgency
42
Subdural Hematoma
forms slowly from venous bleed
| under dura from tears in veins crossing subdural space
43
Intracerebral hemorrhage
blood vessels w/in brain ruptures
| blood leaks inside brain
44
Subarachnoid Hemorrhage
bleeding into subarachnoid space
head trauma/spontaneous
ruptured cerebral aneurysm
45
Hematoma Assessment
```
s/s usually result of increased ICP
look for seizure activity
assess airway/breathing patterns
asses VS changes
N/V/Headache/visual disturbances/pupil changes
nuchal rigidity
weakness/paralysis/posturing
CSF drainage from ears or nose
blood fluid surrounded by yellowish stain (halo sign) when on white background
+ for glucose (fluid)
```
46
Subdural Hematoma Etiology/TX
from high-speed impact/injury
spontaneous
sugery
47
Subdural Hematoma s/s
```
headache
confusion
changes in behavior
dizziness
n
v
lethargy
excessive drowsiness
weakness
apathy
seizures
```
48
Subdural v Epidural Progression
S: slow collection of blood, s/s usually w/in 48 hrs, slow progression of mental deterioration, can become chronic
E: brief loss of consciousness, lucid interval (hallmark), rapid deterioration, increasing ICP, death w/in hours if hematoma not drained
49
Hematoma/TBI Interventions
```
monitor respiratory status/airway (increased CO2 = cerebral edema/dilated cerebral arteries)
monitor VS/temp/ICP
head elevation
seizure precautions
maintain normothermia
assess CN fx/reflexes/motor/sensory fx
monitor for CSF drainage
monitor for infection
morphine sulfate (decreases agitation but can worsen condition)
surgical interventions
```
50
Brain Herniations Causes
```
brain tissue, blood and CSF shifted from normal position
head injury
stroke
bleeding
tumor
medical emergency
```
51
Brain Herniations s/s
```
dilated pupils
headache
altered LOC (drowsy > coma)
high blood pressure
bradycardia
seizures
cardiac arrest
```
52
Brain Herniation Interventions
```
surgery
ventriculostomy
craniectomy
osmotic diuretics
corticosteroids
```
53
Head Injury Teaching
```
ensure responsible adult will check LOC
brain edema/increased ICP may not be evident immediately
return to Ed/HCP if these s/s in 2-3 days
change in LOC
worsening headache
stiff neck
visual changes
motor problems
sensory disturbances
seizures
n/v
bradycardia
abstain from alcohol, watch meds, avoid driving
```
54
Spinal Cord Injury
trauma causes partial/complete disruption of nerve tracts/neurons
contusions, laceration, compression
loss of motor fx/sensation/reflex
loss of bowel/bladder control
55
Spinal Cord Injury Causes & Complications
falls, accidents, gunshot/stab wounds
respiratory failure
autonomic dysreflexia
death
56
Transection
spinal cord is damaged or severed partially w/ symptoms depending on place/extent
57
Brown-Sequard Syndrome
hemidisection of spinal cord that affects half of spinal cord
fx/vibration/proprioception/deep sesation on same side of body as damaged = lost
opposite side of body from damage, pain/temp/light touch =lost
58
Spinal Assessment
respiratory status
motor/sensory changes
loss of bowel/bladder control (urinary retention/distension)
no sweat produced on paralyzed areas
injury above C4 causes respiratory difficulty/paralysis of all extremities
Injured thoracic level can mean paralysis of movement of chest/trunk/bowel/bladder and legs
T6 or above = autonomic autonomic dysreflexia (^ sweating, bradycardia, hypertension, nasal stuffiness, gooseflesh)
Lumbar/Sacral Injuries (loss of fx of lower extremities)
s2/3 center on urination (bladder contracts but won't empty)
59
-plegia
stroke/paralysis
60
-paresis
weakness
61
-hmi/semi
both limbs on one side
62
di-/para-
both upper limbs (di) or both lower limbs (para)
63
quadri/tetra
all four limbs
64
Quadriplegia
lower limbs completely paralyzed complete/partial paralysis of upper limbs
usually due to injury of cervical spinal cord
65
Quadriplegia Assessment
frequently assess breath sounds, accessory muscle use, vital capacity, tidal volume, arterial blood gas values
66
Quadriplegia Interventions
ROM exercises to affected joints
turning necessary
bladder/bowel training programs
Turn every 2 hours
67
Emergency Management of Spinal Cord Injuries
always suspect spinal cord injury until ruled out
immobilize patient
head in neutral position
improper movement can cause further damage
assess resp pattern/maintain airway
don't twist/turn body
don't allow in sitting posotion
cervical fracture: c-collar, halo traction
68
Spinal Cord CV
monitor for dysrhythmias
assess for hemorrhage/bleeding around fracture site
look for signs of shock
assess lower extremities for DVTs
69
Spinal Cord Injuries GI/GU
```
assess for distention/hemorrhage
monitor bowel sounds
high fiber diet
admin stool softeners as needed
maybe catheterization
```
70
Spinal Shock
complete but temporary loss of motor/sensory/reflex/autonomic fx
immediately after injury
71
Spinal Shock s/s
```
flaccid paralysis
loss of reflex below injury
bradycardia
hypotension
paralytic ileus
usually 48 hours but up to several weeks
absent bulbocavernosus reflex
```
72
Neurogenic Shock
```
most common in injuries above T6
soon after injury
massive vasodilation
pooling of blood in BV
tissue hypoperfusion
impaired cellular metabolism
```
73
Autonomic Dysreflexia
common cause
high spinal cord injury T6 and above
uncompensated sympathetic nervous system stimulation
bladder irritation due to distention, bowel impaction
74
Autonomic Dysreflexia Classic Signs
```
hypertension (up to 300 SBP)
throbbing headache
diaphoresis above level of injury
bradycardia (30-40)
piloerection (goose bumps)
flushing
nausea
```
75
Autonomic Dysreflexia Life-Threatening Condition
hypertensive stroke
| seizures
76
Autonomic Dysreflexia Interventions
```
check bp when headache reported
assess urination (may need catheter)
assess constipation (digital rectal examination)
remove constrictive clothing
notify HCP
alpha-adrenergic blocker
arteriolar vasodilator (amlodipine)
HOB to 45 degrees or high Fowler's to lower BP
don't have patient flat/side-lying
```
77
Meningitis
inflammation of meninges covering brain &spinal cord
78
Bacterial meningitis
classic
s/s
testing
fever, severe headache, n/v, nuchal rigidity
photophobia, AMS, other signs of increased ICP
Brudzinski & Kernig's
79
Meningitis in Infants/Children
fever, restlessness, high-pitched cry
bulging fontanels
increasing head circumference
80
Acute Complications of Bacterial Meningitis
```
hydrcephalus
increased ICP from CSF obstruction
permanent hearing loss
learning disabilities
brain damage
```
81
pulse pressure
difference between sBP & DBP
82
Cushing's Triad
systolic HTN w/ widened pulse pressure, bradycardia, respiratory depression
occur very late if increased ICP not treated
83
Brudzinski/Kernig's
severe neck stiffness cause hips/knees to flex when neck is flared
stiffness of hamstring causes inability to straighten the leg when hip is flexed to 90 degrees
84
Lumbar Puncture
CSF assess for color/contents/pressure
85
Normal CSF
```
clear
colorless
small amount of protein, glucose, WBCs
no RBCs/microorganism
pressure is 60 -150 in water
```
86
Contraindication to Lumbar Puncture
Increased ICP
87
Highest Priority Meningitis Intervention
fluid resuscitation to counter hypotension
88
Sepsis & Meningitis
vasopressors (norepinephrine, phenylephrine, vasopressin, dopamine) once fluid resuscitation adequate
obtain labs & blood cultures prior to admin ABX
administer empiric ABX (w/in 30 min of admin)
prior to a lumbar puncture head CT scan
assist w/ LP for CSF examination & cultures (usually purulent/turbid in clients w/ bacterial meningitis)
89
Bacterial meningitis interventions
medical emergency
high mortality (25%) if untreated
empriric ABX started immediately
need peripheral IV to remain in place
90
Viral Meningitis
self-limiting
ABX not effective
usually not serious
s/s leave in 2 weeks
91
If suspected bacterial miningitis
droplet precaution until bac id'd and tx started
92
Miningococcal meningitis & Haemophilus influenzae type B meningitis
highly transmissible to others
precautions discontinued after 24 hours post ABX
viral meningitis usually does not require droplet
