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. Assaults 3. Falls 4. Sports-related trauma

Mechanisms of Injury
Head 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 and by bone fragments from skull fracture Coup-countercoup Injuries- term used for complex head injury
coup- French word which means blow Scalp injuries- can cause lacerations, hematomas, and

contusions and abrasions Skull fracture- often caused by a force of sufficient to fracture 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 are seen 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 head

injury because there is no focal lesion to remove

-involves entire tissue of the brain 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 with incomplete 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 the subdural space Intracerebral hematoma- occurs less often than epidural in subdural hematomas - caused by bleeding directly into the brain tissue

Pathophysiology
Kinetic energy transmitted to the brain
Rapid brain tissue displacement Disruption of Blood vessels Bleeding Tissue injury due to hypoxia Edema

Clinical Manifestations
Skull Fracture CSF and other fluid drainage from the ear or nose Evidence of various nerve injuries Blood behind the tympanic membrane Raccoon eyes Battles 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 Management
Management focuses on supporting all organ functions Ventilatory support Management of fluid 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