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Neurology

Neurology. Management of Patients With Neurologic Trauma Chapter 63. Head Injuries. TBI Traumatic Brain Injury. General Information. Involves injury to Scalp Skull Brain High Risk Groups Male vs. Female? Male Age? < 30yrs #1 Variable Alcohol. Pathophysiology. Damage 

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Neurology

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  1. Neurology Management of Patients With Neurologic Trauma Chapter 63

  2. Head Injuries • TBI • Traumatic Brain Injury

  3. General Information • Involves injury to • Scalp • Skull • Brain • High Risk Groups • Male vs. Female? • Male • Age? • < 30yrs • #1 Variable • Alcohol

  4. Pathophysiology • Damage  • Swelling  • h ICP  • Displacement  • i Blood flow  • i O2  • Ischemia  • Infarction • Deathmosis

  5. Scalp Injuries • Clinical manifestation • Bleeding • Profusely!

  6. Scalp Injuries • Abrasion: • Wound caused by • Rubbing or • Scrapping the skin

  7. Scalp Injuries • Contusion: • Injury to the tissue without… • Breaking the skin

  8. Scalp Injuries • Laceration • The act of… • Tearing

  9. Scalp Injuries • Avulsion • The… • Tearing away of a structure or part

  10. Scalp Injuries • Complication • Infection • Clean • Use procaine/Lidocaine • Suture

  11. Skull Injuries / Fractures • Classifications • Linear • Line • Comminuted • A bone is shattered into many pieces • Depressed • Comminuted fx in which broken bones are displaced inward

  12. Skull Injuries / Fractures • Classifications • Basilar: • Breaks in boned at the base of the skull • Open: • The dura is torn • Closed • The dura is intact

  13. Skull Injuries / Fractures • Clinical manifestations • Local injury • Pain • Persistent • Swelling? • Sometimes

  14. Skull Injuries / Fractures • Clinical Manifestations • Halo Sign • Description • Blood stain surrounded by a yellowish ring • Indication • CSF leak

  15. Skull Injuries / Fractures • Clinical Manifestations • Basilar • Hemorrhage from • Nose • Pharynx • Ears • Blood under the • Conjunctiva • Battle’s sign • CSF otorrhea • CSF rhinorrhea

  16. Skull Injuries / Fractures • Diagnostic Tests • X-ray • CT • MRI • Angiography • Hematoma

  17. Skull Injuries / Fractures • Medical Management • Non-depressed skull fractures • Usually do no require • Surgical treatment • Do require close • Observation

  18. Skull Injuries / Fractures • Medical Management • Depressed skull fractures • May require surgery • Surgical debridement • Antibiotics

  19. Quote from text “After the skull fragments are elevated, the area is debrided. Large defects can be repaired immediately with bone or artificial grafts; if significant cerebral edema is present, repair of the defect can be delayed for 3-6 months.”

  20. Skull Injuries / Fractures • Medical Management • Basilar skull fractures • Usually open or closed? • OPEN • Keep nose and ears • Clean • Sterile cotton pad/ball • Loosely inserted • Instruct pt not to • Blow nose • HOB: • Up • I-ICP protocol

  21. Question?????? • You notice the sheet under a patients head is red with blood, but the stain has a yellowish ring around it. What would be a priority nursing actions? • Notify MD • Infection control!! • Act first -- document last

  22. Question???? • How do you prevent infections in a patient with a head wound? • Clean • Inject antibiotic

  23. A patient enters the ER following a MVA where he was thrown from the car. He has a major head wound. His vital signs show very low blood pressure. What does this indicate? • Hypovolemia • More than just head injury

  24. Question???? • An open skull fracture means what? What nursing measures do you implement? What are the risks? • Dura mater is torn • CSF leakage possible • Increase risk of infection

  25. Question????? • What kind of an injury produces hemorrhaging from the nose, pharynx and ears? • Basil skull fracture

  26. Question???? • Do you give morphine for pain to a patient with head injury? Why or why not? • NO • Interferes with accurate neuro assessment

  27. Brain Injury • Concussion • Pathophysiology • Temporary loss of neurologic function with no apparent • Structural damage • Closed / open? • Closed • Duration of unconsciousness? • Seconds to few minutes

  28. Brain Injury • Concussion • S&S • LOC • Memory loss • Headache

  29. Brain Injury • Concussion • Emergency S&S • Difficulty awakening • Dysphasia • Confusion • Severe H/A • Vomiting • Weak on one side

  30. Brain Injury • Concussion • Diagnostic tests • CT • MRI • X-ray • Neuro checks

  31. Brain Injury • Concussion • Medical treatment • Analgesics • Mild • Observe for post-concussion syndrome • Return to ER if you see any of the emergency S&S

  32. Brain Injury • Concussion • Gerontologic Considerations • Will recover more • Slowly with • More complications

  33. Brain Injury: Contusion • Pathophysiology • The brain is bruised, with possible surface hemorrhage • Duration of unconsciousness: • More than concussion • Potential of infarction & necrosis

  34. Brain Injury: Contusion • Contracoup/Contralateral Phenomenon • Damage to brain occurs opposite to impact

  35. Brain Injury: Contusion • Symptoms: Similar to shock • Activity • Motionless • Pulse • Faint • Respirations • Shallow • Skin • Cool & pale • Bowel & bladder • Evacuation • BP • i • Temp • i

  36. Question???? • Is a concussion an open or closed head injury? • Closed • Is a contusion an open or closed head injury? • Closed

  37. Brain Injury: Intracranial Hemorrhage • A collection of blood that develops within the cranial vault • Small & fast vs. large & slow • Symptoms are frequently delayed

  38. Question???? • Which is more fatal, a small hematoma that develops rapidly or a large hematoma that develops slowly? • Fast = Fatal

  39. Brain Injury: Intracranial Hemorrhage • Epidural hematoma / Extradural hematoma • Blood collects • Btw the skull & dura • Usually due to • Fx of skull • Type of blood vessel • Arterial bleed • Onset of symptoms • Rapid

  40. Brain Injury: Epidural hematoma • Clinical manifestations • Time of injury • Momentary loss of consciousness • Lucid interval • Compensation • Sudden S&S of compression

  41. Brain Injury: Epidural hematoma • Management • Extreme emergency • Burr Holes

  42. Brain Injury: Subdural Hematoma • Collection of blood • Btw dura & brain • Usually due to • Trauma • Venous blood

  43. Brain Injury: Intracerebral Hemorrhage & Hematoma • Bleeding into • Brain • Usually due to • Aneurysm • Missile injuries

  44. Management of Brain Injuries • Treatment of I-ICP • Assume spinal injury • Baseline neurological assessment • Brain Death

  45. Question? • What type of hematoma’s are usually associated with arterial bleeds? • Epidural • What type of hematoma’s are usually associated with venous bleeds? • Subdural

  46. Spinal Cord Injury • Etiology • Male vs Female • Male • Variable • MVA • Age • < 30 yrs • Most frequently involved area • C-5,6,7 • T12-L1

  47. Spinal Cord Injury • Pathophysiology • Transient concussion • Contusion • Laceration • Compression • Complete transection

  48. Spinal Cord Injury • Clinical manifestations • Incomplete spinal cord lesions • Neurologic Level • Lowest level where sensory & motor function are normal

  49. Question????? • Is it possible to break your back (vertebrae) without damaging your spinal cord? • Yes

  50. Spinal Cord Injury • Below neurologic level • Loss of sensory and motor function • Loss of B&B control • Loss of sweating • i in BP

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