Traumatic Brain Injury.pptx
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Transcript of Traumatic Brain Injury.pptx
7/28/2019 Traumatic Brain Injury.pptx
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Traumatic Brain Injury An insult to the brain that is capable of producing
intellectual, emotional, social and vocational changes
30 % of cases are fatal 20 % die of secondary brain injury
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Secondary Brain Injury Includes:
Ischemia from hypoxia and hypotension
Secondary hemorrhage and; Cerebral edema
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Etiology and Risk Factors Leading causes
1. Motor-vehicle accidents
2. Assaults3. Falls
4. Sports-related trauma
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Mechanisms of InjuryHead injuries are caused by a sudden impact force to the
head or inertial forces within the skull
Three Major Mechanisms of Injury: Penetrating injury
Diffuse Injuries such as a blow to the skull
Rebound of the cranial contents may result in an area
of injury opposite the point of impact
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Other Mechanisms Penetrating trauma- a form of primary injury and
includes the head wounds made by foreign bodies andby bone fragments from skull fracture
Coup-countercoup Injuries- term used for complexhead injury
“coup”- French word which means blow
Scalp injuries- can cause lacerations, hematomas, andcontusions and abrasions
Skull fracture- often caused by a force of sufficient tofracture the skull and cause brain injury
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Three Types of Skull Fracture Linear Skull Fracture- appear as thin lines on X-ray
and does not require treatment
Depressed Skull Fracture- maybe palpated and areseen on x-ray
Basilar skull fracture- occurs in bones over the base of the frontal and temporal lobes, manifested as
ecchymosis around the eyes and behind the ears or by blood or CSF leakage from the ear
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Brain Injuries A. Concussions- head trauma resulting from a blow
B. Contusion- the brain itself is injured or damaged
C. Diffused axonal injury- most severe form of headinjury because there is no focal lesion to remove
-involves entire tissue of thebrain and occurs at the microscopic level
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Types of Diffused Axonal Injury Mild- Loss of consciousness and 6-24 hours, short
term disability
Moderate- coma lasting less than 24 hours withincomplete recovery on awakening
Severe involves primary injury to the brain stem.
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Focal Injuries Epidural hematoma(extradural hematoma)- forms
between the skull and the dura matter
Subdural hematoma- collection of blood in thesubdural space
Intracerebral hematoma- occurs less often thanepidural in subdural hematomas
- caused by bleeding directly into the brain tissue
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PathophysiologyKinetic energy transmitted to the brain
Rapid brain tissue displacement
Disruption of Blood vessels
Bleeding
Tissue injury due to hypoxia
Edema
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Clinical ManifestationsSkull Fracture
CSF and other fluid drainage from the ear or nose
Evidence of various nerve injuries Blood behind the tympanic membrane
Raccoon eyes
Battle’s sign
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Cranial Nerve and Inner Ear damage Visual Changes
Hearing loss /disturbances
Anosmia
Dilated pupils
Facial paresis or paralysis
Vertigo
Nystagmus
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Diagnostic Procedures Physical Exam
History
Skull X-ray MRI
CT-Scan
Glasgow Coma Scale
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Medical ManagementManagement focuses on supporting all organ functions
Ventilatory support
Management of f luid balance and elimination Management of nutrition and gastrointestinal
function
Lab tests
Lowering ICP
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Surgical Management Removal of epidural clot by craniotomy
Debridement for penetrating wounds
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Nursing Management Assessment
Level of Consciousness
Vital signs Neurovital Signs
Maintaining nutrition
Monitoring intake and output