N. Trauma

• Neurologic trauma


  Trauma involving the central nervous system that can be life threatening and may result in major physical and psychological dysfunction, altering the patient's life completely

  
• Neurologic trauma


  Trauma involving the central nervous system that can be life threatening and may result in major physical and psychological dysfunction, altering the patient's life completely

  
• Neurologic trauma affects the patient, the family, the health care system, and society as a whole because of its major sequelae and the costs of acute and long-term care
• Neurologic trauma affects the patient, the family, the health care system, and society as a whole because of its major sequelae and the costs of acute and long-term care
• Spinal cord injury


  When the spinal cord is damaged, the messages from the brain cannot get through. Reflex movements can happen, but these are not movements that can be controlled.

  
• Spinal cord injury


  When the spinal cord is damaged, the messages from the brain cannot get through. Reflex movements can happen, but these are not movements that can be controlled.

  
• Neurologic trauma


  An injury in the central nervous system (brain and spinal cord) that causes life-threatening event and impairment physically, mentally, emotionally, socially and financially

  
• Neurologic trauma


  An injury in the central nervous system (brain and spinal cord) that causes life-threatening event and impairment physically, mentally, emotionally, socially and financially

  
• Neurologic trauma affects the family and the society in general (healthcare during rehabilitation)
• Neurologic trauma affects the family and the society in general (healthcare during rehabilitation)
• Head injury


  Broad classification that encompasses any damage to the head (scalp, skull and brain) as a result of trauma
• Head injury


  Broad classification that encompasses any damage to the head (scalp, skull and brain) as a result of trauma
• A head injury does not necessarily mean a brain injury is present
• A head injury does not necessarily mean a brain injury is present
• Traumatic brain injury (TBI)

  An injury that is the result of an external force and is of sufficient magnitude to interfere with daily life and prompts the seeking of treatment

  
• Traumatic brain injury (TBI)

  An injury that is the result of an external force and is of sufficient magnitude to interfere with daily life and prompts the seeking of treatment

  
• Most common causes of TBIs

  • Falls (35.2%)
  • Motor vehicle accidents and crashes (17.3%)
  • Being struck by objects and sport injuries (16.5%)
  • Assaults and violence (10%)
• Children 0 to 4 years, adolescents 15 to 19 years, and adults 65 years and older are most likely to sustain a TBI
• In every age group, TBI rates are higher (twice) for males than for females
• There's an increase of 2% per year in TBI
• Most common causes of TBIs

  • Falls (35.2%)
  • Motor vehicle accidents and crashes (17.3%)
  • Being struck by objects and sport injuries (16.5%)
  • Assaults and violence (10%)
• Half of the people who suffers from TBI are now living with disability
• Children 0 to 4 years, adolescents 15 to 19 years, and adults 65 years and older are most likely to sustain a TBI
• In every age group, TBI rates are higher (twice) for males than for females
• Injuries can range from mild concussion to severe permanent brain damage
• There's an increase of 2% per year in TBI
• Preventing head and spinal cord injuries

  • Advise drivers to obey traffic laws and to avoid speeding or driving when under the influence
  • Advise all drivers and passengers to wear seat belts and shoulder harnesses
  • Caution passengers against riding in the back of pickup trucks
  • Advise motorcyclists, scooter riders, bicyclists, skateboarders, and roller skaters to wear helmets
  • Promote educational programs that are directed toward violence and suicide prevention
  • Provide water safety instruction
  • Educate patients about steps that can be taken to prevent falls, particularly in older adults
  • Advise athletes to use protective devices
  • Recommend that coaches be educated in proper coaching techniques
  • Advise owners of firearms to keep them locked in a secure area where children cannot access them
• Primary injury


  The consequence of direct contact to the head/brain during the instant of initial injury, causing extracranial focal injuries and possible focal brain injuries

  
• Half of the people who suffers from TBI are now living with disability
• Secondary injury


  Evolves over the ensuing hours and days after the initial injury and results from inadequate delivery of nutrients and oxygen to the cells
• Injuries can range from mild concussion to severe permanent brain damage
• Identification, prevention, and treatment of secondary injury are the main foci of early management of severe TBI
• Preventing head and spinal cord injuries

  • Advise drivers to obey traffic laws and to avoid speeding or driving when under the influence
  • Advise all drivers and passengers to wear seat belts and shoulder harnesses
  • Caution passengers against riding in the back of pickup trucks
  • Advise motorcyclists, scooter riders, bicyclists, skateboarders, and roller skaters to wear helmets
  • Promote educational programs that are directed toward violence and suicide prevention
  • Provide water safety instruction
  • Educate patients about steps that can be taken to prevent falls, particularly in older adults
  • Advise athletes to use protective devices
  • Recommend that coaches be educated in proper coaching techniques
  • Advise owners of firearms to keep them locked in a secure area where children cannot access them
• Monro–Kellie hypothesis


  Explains the dynamic equilibrium of cranial contents - the cranial vault contains brain, blood, and cerebrospinal fluid (CSF), and if one of the three components increases in volume, at least one of the other two must decrease in volume or the pressure will increase
• Primary injury


  The consequence of direct contact to the head/brain during the instant of initial injury, causing extracranial focal injuries and possible focal brain injuries

  
• Secondary injury


  Evolves over the ensuing hours and days after the initial injury and results from inadequate delivery of nutrients and oxygen to the cells
• Identification, prevention, and treatment of secondary injury are the main foci of early management of severe TBI
• Pathophysiology of head injury

  1. Brain suffers traumatic injury

  2. Swelling, bleeding and increased intercranial pressure (ICP) occur

  3. Rigid cranium allows no expansion of content

  4. Pressure on the blood vessels within the brain

  5. Cerebral hypoxia

  6. Brain herniation

  7. Cerebral blood flow cessation

  8. Death

  
• Monro–Kellie hypothesis


  Explains the dynamic equilibrium of cranial contents - the cranial vault contains brain, blood, and cerebrospinal fluid (CSF), and if one of the three components increases in volume, at least one of the other two must decrease in volume or the pressure will increase
• Nursing care for head injury

  • Ask patient and significant others not to sleep until physician is notified
  • Have ICU, infusions, widening of pulse pressure, give diuretic (mannitol) ready
  • Assess Glasgow coma scale and reflexes
  • Remove stimulating factors that increase intercranial pressure
  • Assess for escape of cerebrospinal fluid in nose and ears
  • Check oxygen saturation and give 2L/min using cannula
  • Check abdomen for clicking sounds