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what are the 3 components of the head

brain tissue
*monroe kelly hypothesis is if the volume of one of the 3 increases then the volume of the other two must decrease


when ICP is increases what is the first thing that displaces in the head

cerebral spinal fluid
*next thing to go is blood volume then brain tissue herniates into the foreman of monroe because it has no where else to go


what is an ominous sign of potential brainstem herniation and impending death

cushings triad
*systolic hypertension with widening pulse pressure


what is a sign of increased ICP

when pt is talking and all a sudden vomits or has posturing


why do cranial nerves matter

can be compressed as the brainstem is compressed, and warn of impending herniation


what cranial nerve is olfactory (smell)

cranial 1


what cranial nerve is vision

cranial 2


what cranial nerve is pupillary reaction

cranial 3


if patient has vision problems what can you do to help them

show them around the room, show them always, leave call light with them, when they are eating describe their plate like a clock


what are the 3 points in time death can occur after a head injury

immediately after the injury (massive head injury)
within 2 hours after injury (increase in bleeding or swelling)
3 weeks after injury
(ischemia, been in hospital long enough to become septic)


where is a basilar skull fracture and what are symptoms

at the base of skull
CSF leaks from ears, nose, or both
*dont pack ears or nose to stop it, don't use NG tube either


how long does a mild concussion last

30 minutes


how long does a classic concussion last

unconscious lasting less than 6hrs


moving force that hits stationary head

acceleration injury
*gunshot to stationary head


moving head hits stationary object

deceleration injury
*fall and hits ground


moving head hits a moving object

acceleration/deceleration injury
*car crash head on


what is coup-contrecoup

brain hits skull surface (coupe) brain hits the skull surface opposite of first hit (contrecoup)


tearing twisting of the brain

diffuse axonal injury
*know it happens because pt comes in unconscious and stays unconscious


clinical signs of diffuse axonal injury

decrease LOC
increased ICP
decerebrate or decorticate
global cerebral edema


results from bleeding between the dura and the inner surface of the skull

epidural hematoma
*walking dead man because knocked out at the scene but regains consciousness at some point and becomes unconscious again


occurs from bleeding between the dura mater and arachnoid ayer of the meningeal covering of the brain

subdural hematoma
*a tear in the small bridging veins is the most common source
slower than an epidural bleed


after initial bleeding, subdural hematoma may appear to enlarge over time, rebelled, or never really stop is called...

subacute subdural hematoma
*can happen to children


subdural that you can't see any changes due to big amount of space in the head
seen in chronic alcoholics from cerebral atrophy

chronic subdural hematoma
*peak incidence in sixth and seventh decade of life as we get older brain shrinks


occurs from bleeding within the parenchyma

intracerebral hematoma
*usually occurs within the frontal and temporal lobes


can not evacuate this hematoma but you can open up a skull flap to let swelling go out

intracerebral hematoma


bleeding into the subarachnoid space

subarachnoid hematoma


a pt with a subarachnoid hematoma will say they have...

migraine, light sensitive, nuchal rigidity, nausea and really high BP


what is important to know about a berry aneurysm

if we don't control HTN it will blow
*prevent vasospasm by giving calcium channel blocker nimodipine (give on time every day)


what is the nursing assessment of a head injury

glasglow coma scale
neuro check
presence of CSF leak


what is the best position to have injured head at

pt semifowlers (30 degrees) and head midline so they can drain from both sides