Traumatic Brain Injury

Traumatic Brain Injury (TBI)

A TBI occurs when an external force causes the brain to displace within the skull, disrupting normal function.

TBI Mechanisms of Injury

• Penetrating

• Closed/Blunt Trauma

Penetrating

Objects like bullets or ice picks entering the skull.

Closed/Blunt Trauma

Falls or hits that do not break the skull but shake the brain.

TBI Priority Action

Whenever a head injury is suspected, you must rule out a C-spine injury before removing any stabilization devices.

Linear Skull Fracture

A single, non-displaced fracture line; typically the most common and least worrisome.

Depressed Skull Fracture

Bone is pushed inward toward brain tissue. This is a major emergency; patients may have a "lucid interval" before rapidly deteriorating.

Basilar Skull Fracture

A life-threatening fracture at the base of the skull. Key nursing assessments include

Basilar Skull Fracture Key nursing assessments include

• Raccoon Eyes

• Battle Sign

• Hemotypanum

• CSF Leakage

Raccoon Eyes

Periorbital bruising.

Battle Sign

Bruising behind the ear (postauricular)

Hemotypanum

Blood or bruising behind the eardrum.

CSF Leakage

Clear drainage from the nose (rhinorrhea) or ears (otorrhea). Test this fluid for a "halo" sign on gauze or for the presence of glucose.

A concussion is

the mildest TBI, caused by the brain "shaking" within the skull.

Concussion Diagnosis

It is a clinical diagnosis based on history and symptoms; it cannot be seen on X-ray or CT.

Concussion Criteria

Diagnosis requires three or more symptoms, such as nausea, headache, dizziness, memory problems, or irritability.

Secondary Impact Syndrome (SIS)

This is a critical complication where a second concussion occurs before the first has healed. It causes rapid brain swelling, increased intracranial pressure (ICP), and can lead to death.

SIS Patient Education

Athletes must be symptom-free for 10 days before returning to play.

Chronic Traumatic Encephalopathy (CTE)

Permanent brain damage and dementia resulting from repetitive concussions.

TBI Diagnostic Tools

• CT Scan

• X-ray

• MRI

CT Scan

The most common imaging for injury protocols; specifically non-contrast.

X-ray

Used if suspicion is low and there is a desire to limit radiation.

MRI

Rarely used for acute trauma; more common for vascular or degenerative concerns.

Post-Injury Complications

• Cerebral Edema & Increased ICP

• Hyponatremia/SIADH

• Hyperthermia

• Infection

• Brain Hematomas: Coup and Counter-Coup

Cerebral Edema & Increased ICP

Swelling that compromises brain perfusion.

Hyponatremia/SIADH

Damage to the pituitary gland can lead to Syndrome of Inappropriate Antidiuretic Hormone (SIADH).

Hyperthermia

Damage to the hypothalamus can impair the body's ability to regulate temperature.

Infection

High risk with penetrating injuries or open fractures.

Brain Hematomas

• Coup.

• Counter-Coup

Coup

A bruise on the side of the impact.

Counter-Coup

A "back and forth" injury where the brain hits both the side of impact and the opposite side of the skull.