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



Secondary Brain Injury Includes:

Ischemia from hypoxia and hypotension

Secondary hemorrhage and; Cerebral edema



Etiology and Risk Factors Leading causes

1. Motor-vehicle accidents

2. Assaults3. Falls

4. Sports-related trauma



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



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



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



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



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.



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



PathophysiologyKinetic energy transmitted to the brain

Rapid brain tissue displacement

Disruption of Blood vessels

Bleeding

Tissue injury due to hypoxia

Edema



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



Cranial Nerve and Inner Ear damage Visual Changes

Hearing loss /disturbances

Anosmia

Dilated pupils

Facial paresis or paralysis

Vertigo

Nystagmus



Diagnostic Procedures Physical Exam

History

Skull X-ray MRI

CT-Scan

Glasgow Coma Scale



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



Surgical Management Removal of epidural clot by craniotomy

Debridement for penetrating wounds



Nursing Management Assessment

Level of Consciousness

Vital signs Neurovital Signs

Maintaining nutrition

Monitoring intake and output



Common Nursing Diagnosis Risk for ineffective airway clearance

Ineffective cerebral tissue perfusion

Disturbed thought process

traumatic brain injury.pptx

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