TRAUMATIC BRAIN INJURY

 is caused by a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal
function of the brain (1) TBI is one of the leading causes of death and morbidity in the pediatric
population;
 Traumatic brain injury (TBI) can result from a forceful bump, blow, or jolt to the head or body, or from
an object entering the brain. Not all TBIs result in penetrating or non-penetrating injuries, and children
may struggle to communicate their symptoms.
 The brain is located within the bony calvarium, wrapped in dura, arachnoid, and pia mater layers.
Primary injury occurs when kinetic force is translated to the skull and brain, causing contrecoup injuries.
 Primary injury patterns include skull fracture, brain bruise, epidural hematoma, subdural hematoma,
intraparenchymal hemorrhage, and intraventricular hemorrhage. Epidural hematomas cause a "lucid
interval," subdural hematomas collect blood between the dural covering and brain, and intraventricular
hemorrhages involve bleeding into central cerebrospinal fluid-filled spaces.
 Secondary injury occurs in response to primary events, including diffuse axonal, ischemic, hypoxic, and
vascular compromise. Patient care focuses on minimizing secondary injury through appropriate airway
management and respiratory support.
 Assessing ventilation adequacy in patients with TBI involves considering potential injuries and their
effects on the respiratory system, including hemorrhage, brainstem injury, cerebral edema, spinal cord
injury, airway patency loss, altered oropharyngeal muscle tone, and proinflammatory mediator release.
 Noncranial injuries impact respiratory system, including asthma, contusion, edema, and rib fractures.
 TBI symptoms include loss of consciousness, persistent headache, vomiting, nausea, seizures, eye
dilation, nasal or ear fluids, and sleeplessness.
 TBI management involves airway protection, rapid assessment, control of ICP, and continuous
management using mechanical ventilation and pharmacological therapies. Intubation minimizes cervical
spine injury and minimizes ICP effects.

SPINAL CORD INJURY

 Spinal cord injuries are rare in children, accounting for only 1% to 2% of traumatic injuries. Only 3% to
5% of new SCIs occur in children under 15. Most pediatric spinal cord injuries occur at the cervical spine,
with adult injuries being 30% to 40%.
 Spinal cord injury (SCI) can result from direct injury or damage to surrounding tissue, causing temporary
or permanent changes in sensation, movement, strength, and body functions.
 Understanding anatomy is crucial for predicting spinal cord injury results, respiratory support
requirements, and pulmonary complications. Traumatic injuries can result from bleeding, external
compression, or bony fractures.
 Signs of sci include loss of movement, severe back pain, neck, head, bladder, bowel control issues,
walking difficulties, and joint pain.
 Early management of the pulyonary system after Curs injury is crucial to minimize respiratory
complications and bidden shin.

Neurogenic Pulmonary Edema

 Pulmonary interstitial fluid increase is linked to various CNS insults, including intracranial hemorrhage,
TBI, cerebral spinal injury, strokes, intracranial tumors, epilepsy, infection, and multiple sclerosis. The
incidence varies, with subarachnoid hemorrhage being the most common.
 Catecholamine surge causes cardiopulmonary dysfunction, linked to various neurological events,
including spinal cord injury, TBI, and meningitis.
 Sudden pulmonary edema in CNS injury without cardiac or pulmonary pathology is caused by two
pathways: damage to pulmonary capillary endothelium, alveolar basement membrane, and alveolar
endothelium in circulation.
 Dyspnea, pulmonary crackles, and cardiac failure absence.
 To address NPE, ventilators increase positive end expiratory pressure (PEEP) to decrease pressure
gradient and minimize fluid movement. However, PEEP should be considered for potential effects on
ICP, as increased PEEP may increase ICP.