T9: Head Injury TBI (Traumatic Brain Injury)

Question 1

Traumatic Brain Injury

Answer 1

a blow to the head or a penetrating head injury that damages the brain

Question 2

majority of deaths after a head injury occur immediately after the injury, either from

Answer 2

*the direct head trauma or from massive hemorrhage and shock.

Question 3

Deaths occurring within a few hours of the trauma are caused by

Answer 3

*progressive worsening of the brain injury or internal bleeding.

Question 4

Deaths occurring 3 weeks or more after the injury result from

Answer 4

multisystem failure.

Question 5

Linear fracture occurs when

Answer 5

*there is a break in continuity of bone without alteration of relationship of parts. It is associated with low-velocity injuries.

Question 6

depressed skull fracture

Answer 6

inward indentation of skull and is associated with a powerful blow

Question 7

simple linear or depressed skull fracture

Answer 7

*without fragmentation or communicating lacerations. It is caused by low to moderate impact.

Question 8

comminuted fracture occurs

Answer 8

*occurs when there are multiple linear fractures with fragmentation of bone into many pieces. It is associated with direct, high-momentum impact.

Question 9

r potential complications of skull fractures

Answer 9

*intracranial infections, hematoma, and meningeal and brain tissue damage.

Question 10

The location of the fracture determines

Answer 10

*the clinical manifestations.

Question 11

Basilar Skull Fracture

Answer 11

a specialized type of linear fracture that occurs when the fracture involves the base of the skull. Manifestations can evolve over the course of several hours, vary with the location and severity of fracture

Question 12

clinical manifestations of basilar skull fracture

Answer 12

cranial nerve deficits, Battle’s sign (postauricular ecchymosis), and periorbital ecchymosis (raccoon eyes).

Question 13

Brain injuries are categorized as

Answer 13

diffuse (generalized) or focal (localized).

Question 14

diffuse injury

Answer 14

*damage to the brain cannot be localized to one particular area of the brain.

(e.g., concussion, diffuse axonal)

Question 15

focal injury

Answer 15

damage can be localized to a specific area of the brain.

(e.g., contusion, hematoma)

Question 16

Brain injury can be classified as

Answer 16

minor: GCS 13 to 15
moderate: GCS 9 to 12
severe: (GCS 3 to 8).

Question 17

signs of concussion

Answer 17

*brief disruption in LOC, amnesia regarding the event (retrograde amnesia), and headache. The manifestations are generally of short duration.

Question 18

Postconcussion syndrome can occur

Answer 18

anywhere from 2 weeks to 2 months after the injury.

Question 19

Postconcussion syndrome s/s

Answer 19

*Persistent headache
*Lethargy
*Personality and behavior changes
*Shortened attention span, decreased short-term memory
*Changes in intellectual ability

Question 20

Diffuse Axonal Injury

Answer 20

*widespread axonal damage occurring after a mild, moderate, or severe TBI.

Question 21

s/s of diffuse axonal injury

Answer 21

*varied but may include a decreased LOC, increased ICP, decortication or decerebration, and global cerebral edema.

Question 22

Lacerations

Answer 22

involve actual tearing of the brain tissue and often occur in association with depressed and open fractures and penetrating injuries.

Question 23

contusion

Answer 23

*bruising of the brain tissue within a focal area.

Question 24

what do we ask a patient with a contusion?

Answer 24

ARE YOU ON ANY ANITCOAGULANTS??? BECAUSE THEY HAVE A BRUISING WHICH IS BLEEDING!!

Question 25

Coup-Contrecoup Injury

Answer 25

Dual impacting of the brain into the skull; coup injury occurs at the point of impact; contrecoup injury occurs on the opposite side of impact, as the brain rebounds

Question 26

with contusion what are we monitoring for

Answer 26

*Monitor for seizures *Potential for increased hemorrhage if on anticoagulants

Question 27

Epidural and Subdural Hematoma intervention

Answer 27

Subdural Hematoma intervention Evacuate these (suck them up) and try to decrease ICP in surgery

Question 28

epidural hematoma

Answer 28

*results from bleeding between the dura and inner surface of the skull. neurological emergency

Question 29

Classic signs of an epidural hematoma

Answer 29

an initial period of unconsciousness at the scene, with a brief lucid interval followed by a decrease in LOC. *Headache, nausea, vomiting *Focal findings

Question 30

intervention for epidural hematoma

Answer 30

Rapid surgical intervention to evacuate the hematoma and prevent cerebral herniation, along with medical management for increasing ICP

Question 31

subdural hematoma

Answer 31

occurs from bleeding between the dura mater and arachnoid layer of the meninges

Question 32

*Acute Subdural Hematoma

Answer 32

*Within 24 to 48 hours of injury *Symptoms related to increased ICP *↓ LOC, headache *Ipsilateral pupil dilated and fixed if severe

Question 33

*Subacute Subdural Hematoma

Answer 33

*Within 2 to 14 days of the injury *May appear to enlarge over time

Question 34

*Chronic Subdural Hematoma

Answer 34

*Weeks or months after injury *More common in older adults *Presents as focal symptoms *↑ Risk for misdiagnosis *ETOH-atrophy and falling high percentage *Subtle symptoms-mimic TIA,dementia somnolence,confusion,lethargy,memory

Question 35

Delay in diagnosis of a subdural hematoma in the older adult can be attributed to

Answer 35

symptoms that mimic other health problems in persons of this age group, such as somnolence, confusion, lethargy, and memory loss.

Question 36

Intracerebral Hematoma

Answer 36

*occurs from bleeding within the brain tissue and occurs in approximately 16% of head injuries.

Question 37

Diagnostic Studies

Answer 37

*CT scan (Best diagnostic test to determine craniocerebral trauma) *MRI, PET, evoked potential studies *Transcranial Doppler studies *Cervical spine x-ray *Glasgow Coma Scale (GCS)

Question 38

head injury treatment principles

Answer 38

*Prevent secondary injury *Timely diagnosis *Surgery if necessary

Question 39

For the patient with concussion and contusion interventions include

Answer 39

observation and management of increased ICP are the primary management strategies.

Question 40

intervention for depressed skull fracture

Answer 40

*a craniotomy is necessary to elevate the depressed bone and remove the free fragments. If large amounts of bone are destroyed, the bone may be removed (craniectomy), and a cranioplasty will be needed at a later time.

Question 41

craniotomy

Answer 41

incision of the skull performed to visualize and allow control of the bleeding vessels

Question 42

burr-hole

Answer 42

used in an extreme emergency for a more rapid decompression, followed by a craniotomy.

Question 43

emergent treatment for patients with head injury

Answer 43

*Stabilize cervical spine. REMAIN HEAD IN NEUTRAL POSTION *Administer O2 via non-rebreather mask. *Establish IV access with two large-bore catheters to infuse normal saline or lactated Ringer's solution. *Intubate if GCS <8. *Control external bleeding with sterile pressure dressing. *Remove patient's clothing.

Question 44

maintain patients warmth by

Answer 44

warmth using blankets, warm IV fluids, overhead warming lights, warm humidified O2

Question 45

what GCS indicates intubation

Answer 45

GCS <8

Question 46

objective data for head injury

Answer 46

*Altered mental status *Lacerations, contusions, abrasions *Hematoma *Battle's sign *Periorbital edema and ecchymosis *Otorrhea *Exposed brain

Question 47

otorrhea

Answer 47

CSF leaking from the ear

Question 48

rhinorrhea

Answer 48

CSF leakage from the nose

Question 49

Cushing's triad indicates

Answer 49

impending herniation

Question 50

cushings triad

Answer 50

systolic hypertension with widening pulse pressure, bradycardia with full and bounding pulse, irregular respirations

Question 51

GI/GU objective data for head injury

Answer 51

-Vomiting, projectile vomiting, bowel incontinence -Bladder incontinence

Question 52

neuro objective data for head injury

Answer 52

Altered level of consciousness, seizure activity, pupil dysfunction, cranial nerve deficit(s)

Question 53

muscoloskeletal system objective data for head injury

Answer 53

Motor deficit/impairment, weakness, palmar drift, paralysis, spasticity, decorticate or decerebrate posturing, muscular rigidity/increased tone, flaccidity, ataxia

Question 54

overal all goals for head injury

Answer 54

*Cerebral oxygenation and perfusion *Normothermic *Control pain and discomfort *Free of infection *Adequate nutrition *Maximal cognitive, motor, and sensory function

Question 55

*Hyperthermia-hypothalamus damage goals

Answer 55

*Goal 36°to 37° C *Prevent shivering

Question 56

Eye problems may include

Answer 56

corneal reflex, periorbital ecchymosis and edema, and diplopia.

Question 57

interventions or eye problems

Answer 57

-Loss of the corneal reflex may necessitate administering lubricating eye drops or taping the eyes shut to prevent abrasion. -Periorbital ecchymosis and edema decrease with time, but cold and, later, warm compresses provide comfort and hasten the process. -Diplopia can be relieved by use of an eye patch

Question 58

*Measures for patients leaking CSF

Answer 58

*Head of bed elevated *Loose collection pad under nose/over ear *No sneezing or blowing nose *No NG tube *No nasotracheal suctioning

Question 59

*Acute rehabilitation

Answer 59

*Motor and sensory deficits *Communication issues *Memory and intellectual functioning *Nutrition *Bowel and bladder management

Question 60

what may occur in patients with nonpenetrating head injury

Answer 60

Seizure disorders so Antiseizure drugs may be used prophylactically to manage posttraumatic seizure activity

Question 61

what is often the most incapacitating problem after head injury

Answer 61

*Mental and emotional difficulties-personality changes with progressive coma

Question 62

*Health Promotion -Secondary Prevention

Answer 62

*Prevent car and motorcycle accidents *Wear safety helmets *Use seat belts and child car seats *Home safety to prevent falls