Question

Mr. H is a 30-year-old man. He was riding his bike to work and was struck by a vehicle traveling at 35 miles per hour.  He was comatose with a GCS 7 upon arrival to the ED.

1. What are the leading causes of traumatic brain injury in the United States?  Describe important teaching points in prevention of a TBI.  

2. Traumatic brain injury can be classified into primary brain injury and secondary injury, describe the differences in the two types of injury.  List common types of injury of each.

3. Outline the different components of assessing a patient with a traumatic brain injury.

4. Describe the initial management of a patient with a traumatic brain injury.

5. What are the cardiovascular complication and pulmonary complications from a traumatic brain injury?  Describe the nurse’s role in prevention.  

6. TBI carries a high mortality rate and brain death is an important diagnosis to understand.  Describe what the term brain death means and how the nurse can help the family through this difficult time.

Answer 1

Common causes of traumatic brain injury are,

falls, vehicle-related collisions, violence, sport injuries, explosive blast

PREVENTION OF BRAIN INJURY

SEAT BELTS - always remeber to wear seat belts in a motor vehicle

child safety-encourage children to use safety seats

wear a helmet on a bicycle,motorcycle or scooter

use rails on stairways

sit on a safe stools

never drive under the influence of alcohol

consider placing bars on windows to prevent children from falling

remove all obstacles from pathways

give importance to adequate lighting

PRIMARY BRAIN INJURY

primary brain injury includes, tissue deformation, blood vessel damage, axonal shearing, contusion, necrosis, and disruption of blood brain barrier

primary brain injury consist of focal and diffuse regions example, blow to the head that produces crebral contusions,epidural hematomas and ,subdural hematomas,

there is often loss of consciousness followed by lucency

SECONDARY INJURY

the secondary brain injury consist of hypoxia, cerebral edema, inflammatory cytokinese, mitochondrial damage, and ischemia

primary brain injury occur as a result of mechanical injury at the time of trauma whereas secondary brain injury is caused by physiologic responses to the initial injury

in secondary brain injury edema and hematomas can increase intracranial pressure which willl result in compression and deformation of surrounding brain tissue

TYPE OF HEAD INJURIES

OPEN

scalp lcerations

fractures in the skull

interruption of the dura mater

CLOSED

concussion- it is a jarring of the brain within the skull,with no loss of consciousness

contusions is a bruising type of injury with neurological injuries such as subdural or extradural collection of blood.

fractures

linear,depressed, compound fracture, comminuted fracture

ASSESSMENT

Assessment findings depend on the injury

clinical manifestations usually results from increased ICP

changing neurologicl signs in the client

changes in the level of consciousness

Assess for headache, nausea, and vomitting

vital signs changes,relecting increased ICP

nauchal rigidity( not tested until spinal cord injury is ruled out)

weakness and paralysis

check posturing

CSF drainage from ears or nose

seizure activity

INITIAL MANAGEMENT

monotor respiratory status and maintain a patent airway

monitor neurological status and vital signs incuding temperature

maintain head elevation to reduce venous pressure

prevent neck flexion

initiate seizure precautions

monitor for pain and restlessnesss

instruct the client to avoid coughing because this increases ICP

PREVENT complications of immobility

CARDIOVASCULAR COMPLICATIONS

hypertension,cardiac arrhythmias, hypotension ,left ventricular disfunction

neurogenic cardiac injury is related to brain injury

neurogenic stunned myocardium is caused by release of norepinephrine from myocardial sympathetic nerve terminals

PULMONARY COMPLCATIONS

respiratory failure

acute lung injury

pulmonary edema

pulmonary embloism

INTERVENTIONS

MONITOR RESPIRATORY STATUS AND MAINTAIN PATENT AIRWAY BECAUSE INCREASED co2 LEVELS INCREASE CREBRAL EDEMA

protect the airway through tracheal intubation

treatment of hypoxia consist of increasing the inspired oxygen fraction

suction the patient whenever necessary

monitor for signs of infection

CHECK FOR ECG CHANGES AND CHANGES IN VITAL SIGNS

maintain crebral perfusion in the presence of raises intracranial pressure  

BRAIN DEATH

brain death is also known as brain steam death. In brain death patient no longer has any brain functions . thia means they will not regain consciousness or able to breath without support

CLEAR ALL CONCERNS REGARDING BRAIN DEATH

consider patients cultural background while communicating with relatives