Neurological Alterations (Traumatic Brian Injury - TBI)

Question 1

What are TBI’s defined as ?

Answer 1

Any injury that results in damage to the bran

Question 2

TBI’s can be either _______ or ________ ?

Answer 2

Open or Closed

Question 3

How is a Closed TBI defined ?

Answer 3

The brain is injured, But the skull is not broken, fractured, or penetrated.

The Dura is not Torn

Question 4

How is a Open TBI defined ?

Answer 4

Brain injury, where the skull IS broken, fractured, or penetrated.

The Dura IS torn in a penetrating injury

Question 5

What is important to note with Open TBI’s ?

Answer 5

The Location of the skull fracture

Question 6

____________ skull fractures are the most serious ?

Answer 6

Basillar

Question 7

With Basillar skull fractures, where would you see bleeding ?

Answer 7

EENT

Question 8

______________ is a sign of a skull fracture ?

Answer 8

Battle’s sign

Question 9

What is a Battle’s sign ?

Answer 9

Bruising over the mastoid bone (bone behind the ear)

Question 10

What are other signs of Open TBI’s ?

Answer 10

• Raccoon eyes (peri-orbital bruising)

- Cerebrospinal rhinorrhea

Question 11

What is Cerebrospinal-rhinorrhea ?

What do we want it to do ?

Answer 11

Leaking spinal fluid from your nose

Want it to flow freely until it heals itself

Question 12

How do you tell CSF from other types of drainage ?

Answer 12

CSF will be positive for glucose and the halo test

Question 13

What is the Halo test ?

Answer 13

A ring or halo around a blood spot on sheets

Question 14

What types of skull fractures usually do not require surgery ?

Answer 14

Non-depressed

Question 15

Depressed skull fractures usually require what ?

Answer 15

Surgery

Question 16

What are two types of Focal injuries that are seen with TBI’s ?

Answer 16

1. ) Contusions

2. )Hematomas

Question 17

What are Contusions usually seen with ?

Answer 17

Seen with Blunt trauma or acceleration-deceleration injuries like whiplash

Question 18

With Contusion injuries, the brain is ________ and ___________ ?

Answer 18

Bruised and damaged

Question 19

A small hematoma that develops rapidly may be what ?

Answer 19

Fatal

Question 20

A massive hematoma that develops slowly may do what ?

Answer 20

May allow the client to adapt

Question 21

A fast and acute bleed will cause what ?

Answer 21

Instant ICP

Question 22

What is the Pathophysiology of an Epidural Hematoma ?

Answer 22

A rupture or laceration of the middle meningeal artery

(fast bleeder under high pressure)

Question 23

What is the progression of symptoms in a client with an Epidural Hematoma ?

Answer 23

Injury –> loss of consciousness –>Recovery period –> Bleeding into their head (increased ICP) –> Can’t compensate anymore –> Neuro changes –> Coma

Question 24

What are the Tx’s for an Epidural Hematoma ?

Answer 24

• Burr holes (to remove the clot, stop the bleeding, and control the ICP)

Question 25

What types of questions do you want to ask to someone with an Epidural Hematoma ?

Answer 25

- Did they pass out and stay out ? - Did they pass out, wake up, and pass out again ? - Did they just see stars ?

Question 26

An Epidural Hematoma is what ?

Answer 26

An Emergency!

Question 27

What is the Pathophysiology of a Subdural Hematoma ?

Answer 27

A collection of blood between the dura and the brain

Question 28

Subdural Hematomas are usually what types of bleed ?

Answer 28

Venous bleeds (Slower than an arterial)

Question 29

Subdural Hematoma can be what ?

Answer 29

- acute (fast) - Subacute (medium) - Chronic (slow)

Question 30

What are the Tx's for a Subdural Hematoma ?

Answer 30

- Acute or chronic = immediate craniotomy to remove clot and control the ICP

Question 31

Chronic Subdural Hematomas do what ?

Answer 31

Immitates other conditions (ex: appear drunk, stroke, etc) - Bleeding and compensating - Neuro changes = compensation maxed out

Question 32

What are two types of TBI's ?

Answer 32

a. ) Foacal injuries | b. ) Diffuse Brian injuries

Question 33

What is a type a Diffuse Brian Injury ?

Answer 33

Concussion

Question 34

What is a concussion ?

Answer 34

Temporary loss of neurologic function with complete recovery

Question 35

True or false: With a concussion you will have a short period of unconsciousness or they may just get dizzy and see spots ?

Answer 35

True

Question 36

What signs do you want to teach the caregiver that require them to bring the client back to the ED ?

Answer 36

- *Difficulty awakening/speaking - Confusion - Severe headache - vomiting - pulse changes - Unequal pupils - one-sided weakness (signs that the ICP is going up)