EDN: Traumatic Brain Injury

Traumatic Brain Injury

It may occur when a substantial force strikes the skull, which can be blunt, penetrating, or combination of the two

Head trauma

Occurs when the generated force is greater than the cranial vault can absorb, transferring the kinetic injury to the delicate neural tissues beneath

Skull fracture

A distortion in the integrity of the bony skull

Linear Fracture

results from a single blunt strike that creates a fissure line in the cranium

Basal Fracture

results from a backward fall that damages the occiput

Anterior Basilar Skull Fracture

results from a forward fall that damages frontal area

Depressed Skull Fracture

result from a fall and may result laceration of bone tissues

Open Skull fracture

a perforated scalp is observed

Concussion

direct brain injury involving neural tissue, a temporary loss of consciousness that results from a transient interruption on the brain’s normal functioning

Contusion

it is the bruising of the brain tissue that occurs when the head suffers a direct impact with a rigid object.

Diffuse Axonal Injury

describes an extensive damage involving a wide area of neural tissues throughout the cerebrum and brainstem; the damage involves the innermost centroaxial areas of the neural white matter

innermost centroaxial

in diffused axonal injury the damaged involves the _____________ areas of the neural white matter?

Intracranial Hemorrhage

significant bleeding into a space or potential space between the skull and the brain. It can be classified as epidural hematoma, subdural hematoma, or subarachnoid hemorrhage

Concussion

mild traumatic brain injury caused by an impact to the head

Contusion

Blood underneath the skin due to trauma causing a bruise

Diffuse Axonal Injury

similar to concussion though the brain is shaken MUCH MORE violently

Coup Contrecoup

contusion present at both the site of the impact and the exact opposite end of the impact

Epidural bleed

Bleeding between the skull and dura mater:

Subdural Bleed

Bleeding between the dura mater and arachnoid:

Subarachnoid bleed

Bleeding between the arachnoid and pia mater

1. Skull

   1. Epidural space

2. Dura mater

   1. Subdural space

3. Arachnoid mater

   1. Subarachnoid space

4. Pia mater

List the layers of the skull and spaces

cervical spine fracture

Assume a _____________ for any patient with a significant head injury, until otherwise proven

Racoon’s eyes

periorbital ecchymosis

Racoon’s eyes

Common signs of anterior basilar skull fracture

anterior basilar skull fracture

racoon’s eyes is seen in what type of skull fracture?

Battle’s sign

periauricular ecchymosis; a bluish discoloration behind the ears

Battle’s sign

Common sign of basal or occiput skull fracture

Rhinorrhea

CSF leak in the nose

Otorrhea

CSF leak in the ear

pia matter

in TBI why CSF leaks? Because ____________ is no longer intact

Jaw-thrust maneuver

what is the right way to open airway in patients who sustained traumatic brain injury?

gag reflex

Oral suction on standby; be sure not to stimulate ___________ because it can increase ICP

anticonvulsants, mannitol, antibiotics, antipyretics

what are the medications given for traumatic brain injury?

Basilar skull fracture or severe midface fractures

if this type of fracture is suspected NGT is contraindicated?

Contusion

Actual small amounts of bleeding into the brain tissue associated with edema formation and possible tissue necrosis and infarction.

Concussion

a mild diffuse axonal injury resulting in a transient disturbance of neurological function that may or may not include a loss of consciousness

Brain herniation

Intracranial hemorrhage can cause potential ___________

monro-kellie hypothesis

what is hypothesis related to TBI?

epidural hematoma

subdural hematoma

subarachnoid hemorrhages

intracranial hemorrhage can be classified as _________ depending on the site of bleeding.

bulky, loose dressing

what type of dressing to control bleeding in head trauma?

mental status

is the most sensitive indicator of a change in the patient’s condition in head trauma

hypertension and bradycardia

are late signs of increasing ICP

Cushing’s triad

a TRIAD SIGN of increased intracranial pressure (ICP)

hypertension (widened pulse pressure), bradycardia, bradypnea (cheyne-strokes respirations)

what is the cushing’s triad

Mannitol or hypertonic saline

drug to reduce cerebral edema and decrease ICP.

neutral position with cervical spine immoblizer

what is position of the patient with head injury?

PNSS or PLR

what is the IV fluid given to patient with head trauma?

Pia matter

this brain matter is NO longer intact that is why CSF leaks?

stop flow of blood or CSF

in TBI with CSF leakage, Do not attempt to ____________

loose, bulky dressing

Apply ____________ (type of dressing) to prevent too much pressure that may induced increase ICP

NGT instead use orogastric tube

If basilar skull fracture or severe midface fractures are suspected, what procedure is contraindicated??? and what is the substitute?