Head Injuries

TBI, or traumatic brain injury, is caused by any injury to the head.
Common causes:
- Motor vehicle accidents
- Falls greater than 20 feet
- Child abuse, including shaken baby syndrome

Open Head Injury
- Typically involves a basilar skull fracture.
- Key Signs to Note:
- CSF (Cerebrospinal Fluid) leakage from the eyes, ears, and nose.
- Clear fluid drainage that is positive for glucose, indicative of CSF.
- Example NCLEX questions relating to open TBI:
- A client with a head injury and clear nasal drainage should have the drainage checked for glucose.
- The priority patient in mass casualty incidents is one with clear fluid draining from the right ear, indicating a basilar skull fracture.
Closed Head Injury
- No fracture of the skull; the skull remains intact.
- Types of closed TBI include:
- Concussion:
  - A minor TBI from blunt force trauma.
  - Symptoms:
  - Brief loss of consciousness
  - Headache
  - Retrograde amnesia
  - Important NCLEX tip:
  - Confusion with vision loss or pupillary constriction is misleading; these are signs of increased ICP (intracranial pressure).
- Contusion:
  - Major TBI with specific patterns of injury.
  - COUP-COUNTERCOUP Injuries:
  - Coup: Blunt force impacts one side of the skull.
  - Countercoup: The brain slams against the opposite side of the skull, typically affecting the frontal and occipital lobes.
  - Symptoms:
  - Similar to concussion: headache and retrograde amnesia
  - Again, vision loss and changes in mental status indicate increased ICP.

Frontal Lobe:
- Controls speech, memory, and voluntary movement.
- Injury leads to expressive aphasia and memory problems.
- Memory tricks:
- Funnel lobe metaphor for remembering its functions.
Occipital Lobe:
- Controls sight and visual perception.
- Injury leads to vision problems.
- Memory tricks:
- Ocular for Occipital (sight-related) and the 'oo's in occipital.
Temporal Lobe:
- Responsible for hearing.
- Memory tricks:
- Think 'tempo' for auditory processing.
Parietal Lobe:
- Involved in sensory perception and touch.
- Memory tricks:
- Purring kitten symbolism for softness and touch.
Cerebellum:
- Controls balance.
- Memory tricks:
- Think 'cerebellence' for balance control.
Brainstem:
- Responsible for heart rate and respiratory rate.

Epidural Hematoma:
- Most deadly type of hematoma.
- Medical emergency due to rapid bleeding and increased ICP.
- Classic signs:
- Initial loss of consciousness followed by a brief alertness and then loss of consciousness again.
- Clients report feeling sleepy before slipping into a coma, potentially leading to death.
Subdural Hematoma:
- Accumulation of blood beneath the dura mater.
- Less acute than epidural but can still be serious.
Subarachnoid Hematoma:
- Bleeding between the brain and the tissues covering it.

Initial Intervention:
- Stabilize the cervical spine (c-spine) in suspected head or spinal injury cases.
- Maintain perfect alignment of the body.
Assessing Glasgow Coma Scale (GCS):
- Score Ranges:
- 15: Fully awake and alert (highest score).
- Less than 8: Intubation is necessary due to high risk of coma.
- 3: Deep coma, lowest score.
- Important to report any decline in GCS score; lower scores indicate higher lethality.

Agitation:
- Often presented as restlessness or irritability.
Change in Level of Consciousness (LOC):
- Decreased mental status indicates rising pressure.
Sudden Vomiting:
- Emesis occurring without nausea is a significant sign.

Seizures:
Posturing:
- Decorticate and decerebrate posturing presentations.
Cushing's Triad:
- Symptoms indicating severe pressure on the brainstem leading to compromised vital signs.
- Memory trick:
- "Crushed vital signs" indicates severity of brain compression.