CRANIOCEREBRAL TRAUMA

Etiology/Pathophysiology

HEAD INJURY Causes death or serious disability. Second most commom cause of neurological injuries. Major cause of death between ages 1 and 35. Include motor vehicles and motorcycle accidents,falls, industrial accidents, assaults, and sports trauma.

Injuries vary from minor scalp wounds to concussions and open fractures of the skull with severe damage to the brain. May result in injury to the scalp, skull, and brain tissues.

Effects of severe head injury Cerebral Edema Sensory and motor deficits Increased intracranial pressure

Injuries to the brain can result from Direct or Indirect trauma to the head Indirect trauma – is caused by tension strains and shearing forces transmitted to the head by stretching of the neck. Direct trauma – occurs when the head is directly injured

Clinical Manifestations

Open Head Injuries Result from skull fractures or penetrating wounds A skull fracture may also occur Fractures of the base of the skull are more serious because of their location near the medulla

Closed-Head Injuries These include concussions, contusions, and lacerations Laceration of the scalp bleeds profusely Hemorrhage resulting from craniocerebral trauma may occur in the following sites: – Scalp – Epidural – Subdrural – Intracerbral – Intraventricular

Epidural and Subdural Hematomas Epidural – Resulting from arterial bleeding form as blood collects rapidly between the dura and the skull – If lethargy or unconsciousness develops after a patient has regained consciousness and epidural hematoma may be suspected. Subdural – Venous blood collects below the dura – Formation is slow because venous pressue is low – Causes pressure on the brain – Will displace brain tissue – May be classified as acute, chronic, or subacute

Epidural Hematoma Subdural Hematoma CT Scans of Subdural Hematomas Subdural Hematoma

ASSESSMENT

Subjective Data

It is important to determine: - how the injury happened - whether the patient has headache, nausea, or vomitting Note abnormal sensations and history of a loss of consciousness and bleeding from any orifice.

Objective Data

(1) respiratory system (2) level of alertness and consciousness (3) size and reactivity of the pupils Assess: (1) patient’s orientation (2) motor status (3) vital sign (4) the presence of bleeding or vomitting (5) abnormal speech pattern (6) the presence of Battle’s sign

Diagnostic Tests CT MRI PET

Medical Management Immediate care toward life-saving measures. Maintenance of normal body function until recovery is ensured. Maintain a patent airway and ensure adequate oxygenation. Arterial blood gas levels are checked.

Medications are used to reduce cerebral edema and increased intracranial pressure (common problems in patients with head injury) Medications include mannitol and dexamethasone Codeine and other analgesics that do NOT depress the respiratory system Avoidance of Hyperthermia due to an increases of brain metabolism

Nursing Interventions

Prevention of Infection The patients ear and nose are checked carefully for signs of blood and serous drainage, which indicate that the meninges are torn and spinal fluid is escaping

Patient Teaching Observation for complications such as drowsiness, vomiting, worsening headache or stiff neck, seizures, blurred vision, behavioral changes, motor problems, and other sensory problems.