Week 11 TBI/Brain Tumors

Question 1

How do we diagnose TBI?

Answer 1

CT scan

Question 2

what are the two signs that someone has a basal skull fracture?

Answer 2

1. battles sign (post auricular ecchymosis - behind the ear)
2. Raccoon eyes (bilateral periorbital ecchymosis)

Question 3

What is a common complication of facial and skull fractures?

Answer 3

Dural Tear - CSF leak = meningitis risk

Question 4

How do we check for CSF leak in facial and skull fractures?

Answer 4

look for clear fluid coming from nose or ears

Question 5

What is a major risk of skull fracture?

Answer 5

Meningitis - monitor for S&S

Question 6

What tube should we NEVER insert with a facial/skull fracture and why?

Answer 6

NG
can go into the brain

Question 7

How do we know if someone has CSF leak?

Answer 7

Halo sign
- use gauze - will see red in middle and yellowish around

Question 8

What is a focal head injury?

Answer 8

Contusion
- bruising of brain tissue in a focal area

Question 9

What can focal head injury lead to?

Answer 9

increased ICP

Question 10

What is a coup?

Answer 10

Primary impact (think baseball bat hitting a head)

Question 11

What is a contrecoup?

Answer 11

secondary impact
(baseball bat hits head and then brain hits back of head)

Question 12

What is coup-contre coup?

Answer 12

acceleration-deceleration injury
contusions at the site of direct impact and seondary damage on opposite side from force of impact

Question 13

What medical issue is common in contusion?

Answer 13

Seizures

Question 14

What is Diffuse Axonal injury (DAI)?

Answer 14

sheering of axons - widespread damage
mild- concussion or severe

Question 14

What % of people remain in a vegetative state with severe DAI?

Answer 14

90%

Question 15

When can a DAI occur after initial TBI?

Answer 15

12-24 hours

Question 16

What two things can DAI cause in the head?

Answer 16

1. cerebral edema
2. increased ICP

Question 17

What two brain injuries can happen simultaneously?

Answer 17

Focal head injury + DAI

Question 18

What are the two types brain bleeds?

Answer 18

1. Epidural Hematoma
2. Subdural Hematoma

Question 19

Which type of hematoma is emergent and why?

Answer 19

Epidural hematoma
b/c it’s arterial = bleeds fast= rapid IICP

Question 20

what is the intervention for epidural hematoma?

Answer 20

immediate surgery to remove bleed - craniotomy
(nurse care for IICP)

Question 21

What Hematoma is kinda tricky and why?

Answer 21

Subdural Hematoma
b/c it can go undetected
usually venous

Question 22

Which hemotoma is arterial and which is venous?

Answer 22

epidural= arterial
subdural= venous

Question 23

What is an important question to ask to check about subdural hematoma?

Answer 23

“have you fallen in the last 6 months? “

Question 24

what is the intervention for subdural hematoma?

Answer 24

surgery to remove the bleed

Question 25

what do we do at the scene of an MVA as a bystander?

Answer 25

Calm gentle approach Patent airway Stabilize cervical spine until x-ray Apply pressure to external bleeding Warm blankets Assess for rhinorrhea/ottorrhea, scalp wounds

Question 26

What happens if a person has head injury from an MVA at the hospital?

Answer 26

1. O2 - NP or rebreathe 2. 2 large bore IVs - careful with fluid - meds to decrease ICP - meds to increase CPP - meds to control pain - meds to prevent/control seizures 3. keep them warm 4. frequent VS neuro checks (ICP & CPP) 5. Support patient and family 6. prep for surgery if needed

Question 27

What are the 4 types of brain tumors?

Answer 27

1. Primary - from tissue in the brain 2. Secondary - from malignant neoplasm/tumour elsewhere 3. Benign (encapsulated) tumor 4. Malignant (invasive) - glioblastoma

Question 28

What are 2 clinical manifestations of brain tumors?

Answer 28

1. headache (dull) 2. S&S of IICP

Question 29

What are the 6 interventions for brain tumors and what do they do?

Answer 29

1. Corticosteroids to decrease inflammation dexamethasone (Decadron) – IV /PO 2.Ventricular Shunts to decrease hydrocephalus -To drain CSF from ventricles to R Atrium or peritoneum -Cerebral palsy typically 3. Surgery to remove or debulk mass Craniotomy Stereotactic radiosurgery (high dose radiation precisely delivered) 4. Radiation (internal, external) 5. Chemotherapy Can be oral, IV, intrathecally (resevoir placed in crainial ventricle & fill brain) 6. Nursing care for IICP- keep that ICP down!

Question 30

What is a craniotomy?

Answer 30

bone flap removed

Question 31

what is included in craniotomy post op care?

Answer 31

1. close monitor ICP 2. maintain CPP 3. Assess, prevent and treat complications 4. prevent infection/do dressings 5. Pain & nausea control 6. antiseizure meds

Question 32

What are complications of craniotomy?

Answer 32

1. PN 2. stress 3. gastric ulcer 4. DVT/PE 5. Constipation 6. Fluid & lytes imbalance 7. SIDH 8. DI

Question 33

What is a common issue in patients with brain injury that affects the whole family?

Answer 33

personality changes

Question 34

What is a common surgery option for subdural hematoma?

Answer 34

Burr hole

Question 35

What is sterotactic surgery?

Answer 35

1. Stereotactic Radiosurgery - radiation to destroy brain tumour - gamma knife 2. Stereotactic Bx/Surgery- biopsy, small tumors, abscesses