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Pupil Response in Brain Injury

• Pupils may become unequal in size during brain injuries.

• Typically, dilation occurs on the side opposite the injury.

• Slower dilation in both eyes may indicate brain herniation.

• Fixed and dilated pupils indicate severe brain injury.

Brain Compression Effects

• Elevated intracranial pressure (ICP) can affect heart rate and respiratory function.

• Compression of brain structures can lead to respiratory failure.

• Cheyne-Stokes respiration: deep, irregular breathing pattern may occur.

• Possible seizure activity in the patient.

Signs of Head Trauma

Battle's Sign

• Bruising over the mastoid process indicating potential skull fracture.

• Suggestive of basal skull injury.

Halo Sign

• Indicates cerebrospinal fluid leakage; presents as blood surrounded by clear fluid from ears/nose.

• Used to assess the severity of head trauma.

Diagnostic Imaging for Increased ICP

• CT or MRI scans are critical to identify structural brain changes.

• Midline shift in the brain may indicate herniation; urgent evaluation is needed.

Diagnostic Tests

• Electroencephalogram (EEG): measures brain electrical activity and detects seizure activity.

• Lumbar puncture: should only be performed after CT to prevent worsening of herniation.

Normal ICP and Medical Management

• Normal ICP ranges from 7 to 15 mmHg.

• Management depends on underlying cause of ICP elevation.

• Ensure adequate brain perfusion and oxygenation after identifying the cause.

• Endotracheal intubation may be necessary if respiratory distress occurs.

Surgical Interventions for ICP

Craniotomy

• Involves removal of a bone flap to relieve pressure.

• Allows for brain swelling post-trauma.

Ventricular Drainage

• For patients with hydrocephalus, shunts drain excess cerebral fluid.

Hematoma Evacuation

• Involves using a tube to remove clotted blood from the brain.

Monitoring ICP

• Catheters, bolts, or epidural sensors are used to measure ICP.

• Continuous monitoring is crucial for patients with high ICP.

Medications to Decrease ICP

1. Osmotic Diuretics (e.g., Mannitol): promote fluid excretion.

2. Corticosteroids: reduce inflammation affecting brain tissue.

3. Anticonvulsants: prevent seizures that could exacerbate injury.

Nursing Interventions

• Positional Management: Head of bed elevated 30-45 degrees to reduce ICP.

• Monitor for bending or straining, which could increase ICP.

• Ensure proper alignment of neck and head.

Signs and Symptoms of TBI

• Each year, millions of Americans face TBIs.

• Risk increases for individuals over 75, children under 4, and young adults aged 15-24.

• Five million people live with TBI aftermath; rehabilitation is key.

Types of Head Injuries

Penetrating Injury

• Involves an object breaching the skull, potentially damaging brain tissue.

Closed Head Injury

• The brain collides with the inner skull without external penetration, leading to shearing and diffuse damage.

Classification of TBIs

• Mild TBI: Short-term loss of consciousness, common symptoms include headaches and cognitive deficits.

• Moderate TBI: Unconsciousness lasting up to 24 hours; cognitive impairments observed.

• Severe TBI: Extended unconsciousness or post-traumatic amnesia lasting over 8 days.

• Catastrophic TBI: May appear awake but unable to communicate meaningfully, significant rehabilitation required.

Importance of Support and Monitoring

• Family involvement in recovery is crucial.

• Monitor vital signs, including CO2 levels which may affect cerebral edema.

• Use the Glasgow Coma Scale for neurological assessment.

Specific Monitoring Considerations

• Maintain head elevation to reduce ICP; protect cervical spine.

• Watch for drainage indicating potential CSF leaks, do not clean or suction.

• Patients should avoid straining actions to prevent ICP spikes.