SARAh S.

TAUPAN, RN, MN, DPA

What is Traumatic Brain Injury? Closed head collides with another object but there is no opening through the skull and dura Open object penetrates the skull, enters the brain and damages the soft brain tissue in its path. Exposes the brain

Annual number of people who experience a traumatic brain injury: 1. 4 million annually in the United States Deaths: 50,000 Hospitalization: 235,000 Among children ages 0 to 14 years Deaths: 26, 850 Hospitalizations: 37,000

MILD
loss

SEVERE
loss of consciousness for more than 30 minutes and memory loss after the injury or penetrating skull injury longer than 24 hours Results in permanent neurobiological damage that can produce lifelong deficits to varying degrees.

of consciousness and/or confusion and disorientation is shorter than 30 minutes The person looks normal and often moves normal in spite of not feeling or thinking normal.

Acceleration- occurs when the head is struck by a moving object and set in motion. 2. Deceleration- occurs when the moving head strikes a solid, immobile object. 3. Acceleration & deceleration 4. Deformation- refers to injuries in which the force results in deformation and disruption of the integrity of the impacted body part(i.e. skull fracture)
1.

 A.

By description of injury 1. Blunt trauma 2. Penetrating injuries 3. High velocity objects 4. Coup injury B. According to structures damaged 1. PRIMARY HEAD INJURY 1. SCALP INJURIES 2. SKULL INJURIES

Three types of skull fractures Linear skull fractures Depressed skull fractures Basilar skull fractures Racoons sign, Battles sign, halos sign, otorrhea, rhinorrhea, test CSF

SECONDARY HEAD INJURY - Include Hemorrhage, edema and infection HEMORRHAGE EPIDURAL HEMATOMA SUBDURAL HEMATOMA ACUTE SUBDURAL HEMATOMA CHRONIC SUBDURAL HEMATOMA INTRACRANIAL HEMATOMA BRAIN SWELLING AND EDEMA INFECTIONS
2.

C.

Brain Injuries Concussion Contusions TYPES OF CEREBRAL CONTUSION A. TEMPORAL LOBE CONTUSION B. FRONTAL CONTUSION C. FRONTAL-TEMPORAL CONTUSION D. BRAIN STEM CONTUSION

CONCUSSION
Temporary

loss of neurologic function with no apparent structural damage lasting for a few seconds to few minutes Jarring of the brain that caused it to stop functioning momentarily

CONTUSION More severe injury in which the brain is bruised, with possible surface hemorrhage Unconscious for more than a few seconds or minutes Picture is somewhat similar to that of shock

INCREASED

DROWSINESS AND

CONFUSION INABILITY TO AWAKEN, lucid intervals VOMITING CONVULSION OR FITS BLEEDING OR DRAINAGE FROM NOSE OR EARS

 BLURRING

OF VISION WEAKNESS ON EITHER ARMS OR LEGS SLURRED SPEECH SIGNS OF INCREASED ICP SIGNS OF DIABETES INSIPIDUS : Increase urine output, dry skin, dry mucus membrane check for urine specific gravity

Immobilization Do not attempt to remove penetrating objects Cover head wounds and apply pressure ABC

MAINTAINING THE AIRWAY

Keep

unconscious patient in a position that facilitates drainage of oral secretion Establish effective suctioning procedures Guard against aspiration and respiratory insufficiency

MAINTAIN HYDRATION & ADEQUATE NUTRITION

Maintain

fluid and electrolytes A urinary catheter is maintained It is important to maintain the unconscious patient's blood pressure through IV fluid and medication.

MAINTAINING SKIN INTEGRITY

The

patient is turned and positioned A compression device wrapped around the legs that prevents blood clots. Daily injections are also given to prevent blood clots.

SEIZURE PRECAUTION NO OPIOIDS

 Duration

of Coma. The shorter the coma, the better the prognosis. Post-traumatic amnesia. The shorter the amnesia, the better the prognosis. Age. Patients over 60 or under age 2 have the worst prognosis, even if they suffer the same injury as someone not in those age groups.

What is it? Spinal injuries cause myelopathy or damage to white matter or myelinated fiber tracts that carry signals to and from the brain. It also damages gray matter in the central part of the spine, causing segmental losses of interneurons and motorneurons.

CAUSE: TRAUMA AS VEHICULAR AND DIVING ACCIDENTS, FALLS AND BULLET SHOT WOUNDS; LESS OFTEN BY TUMORS WITHIN THE SPINAL CORD OR OUTSIDE OF THE CORD THAT COMPRESS IT TYPES A. CONCUSSION WITHOUT DIRECT TRAUMA TO THE CORD B. COMPRESSION, CONTUSION OR LACERATION OF THE CORD C. HEMORRHAGE INTO THE CORD D. COMPRESSION OF THE BLOOD SUPPLY TO THE CORD.

 CAUSE-

VIOLENT HYPEREXTENSION AND FLEXION OF THE NECK USUALLY AS A RESULT OF A TEAR DUE TO AUTOMOBILE ACCIDENT SIGNS AND SYMPTOMS: PALE AAND DAZED ; RARELY LOSES CONSCIOUSNESS; MAY EXHIBIT WEAKNESS, GAIT DISTURBANCES; DIZZINESS AND VOMITING; OCCIPITAL HEADACHE, NUCHAL RIGIDITY AND PAIN RADIATING THE ARM. RX: BED REST, ANALGESIC AND HOT PACKS, PLASTIC COLLAR

 CAUSE:

LIFTING HEAVY OBJECTS OR A FALL ON THE BACK SIGNS AND SYMPTOMS: BACK PAINS THAT RADIATES ON THE BACK OF A LEG, DIFFICULTY IN WALKING, MUSCLE SPASM, AND DISORDERS OF A SENSATION RX: IF A SINGLE DISK IS INVOLVED, IT MAY BE SURGICALLY REMOVED. HOWEVER, SPINAL FUSION (UNITING TWO VERTEBRAE) IS USUALLY PERFORMED.

CAUSE:

loss of function inflicted at the time of injury SIGNS AND SYMPTOMS: absence of perspiration, retention of feces and urine, hypotension with slow steady pulse and dry skin

 Stage

of spinal shock sensation and motor power localized below the vertical height of the lesion are lost. This stage lasts for 2 to 3 weeks . Stage of recovery after a period typically ranging from 2 to 3 weeks of injury, the nerves partially recover, and the return of segmental reflexes produce paraplegia-in-flexion. Stage of reflex failure after a period of days the recovered reflexes again start to give way due to complete degeneration of nerve cells.

 C5

Observed respiratory status C6 quadriplegia= priority is atelectasis C8 neurogenic shock : hypotension, bradycardia, warm dry skin Thoracic & below paraplegia Cauda equina syndrome compression in the nerve roots that can lead to permanent loss of bladder and bowel control and paraplegia, refer to the physician STAT

Sacral SCI: 1. Higher than S2 with erection ,no ejaculation 2. S2-S4 no erection, no ejaculation 3. High lesion increase probability to perform sexually 4. Below lesion decrease probability to perform sexually 5. Paraplegia 6. Bowel and bladder incontinence

The severity of The location of the injury. the injury Spinal cord In general, injuries are injuries that are classified as higher in your partial or spinal cord complete, produce more depending on paralysis. how much of the

cord width is damaged.

Thrombophlebitis Measures such as ROM exercises, thigh-high elastic compression stockings, adequate hydration and anticoagulation medications (heparin and warfarin ) as prescribed are given Orthostatic Hypotension Activity should be planned in advance and adequate time given for a slow progression of position changes Autonomic Dysreflexia Stimuli that may trigger this: distended bladder ( most common ); distention or contraction of visceral organs, especially the bowel; or stimulation to the skin, goose flesh

MANAGEMENT

: 1. Keep supine in neutral alignment 2. Immobilized apply C collar 3.Use log rolling technique in turning 4. ABC, Brief neurologic exam 5. Bladder program 6. Baclofen 7. Methylprednisolone

MEDICAL
1.

SURGICAL MGT :

Skeletal Traction: A. Minerva vest provides significant immobilization including lateral flexion B. Gardner wells reduce dislocation, subluxation, pain & spasm C. Halo vest immobilize the neck, opening must be attached to the client 2. Decompression,3. Spinal fusion

 Clinitron

Bed

Tilt

Bed