headinjury-200603080801.pptx neuro injuries

headinjuries

1. HEAD INJURY PRAVEEN KUMAR KOTLA TEACHING FACULTY

2. HEAD INJURY Traumatic brain injury (TBI) is a noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness

3. ETIOLOGY Motor vehicle accidents Falls Assaults Sports-related injuries Fire-related injuries

4. MECHANISM OF INJURY COUP-CONTRECOUP INJURY : The French word “ coup ” means “ blow ”. The client sustained a combined injury at the point of impact & an injury on the site of the brain opposite from the movement of the brain within the skull. Contrecoup : Means opposite side away from the injury.

5. COUP-CONTRECOUP INJURY

6. MECHANISM OF INJURY cont… PENETRATING TRAUMA : A form of primary injury include injury to the skull by any foreign body such as knife, bullets or those made by bone fragments from a skull fracture. SCALP INJURIES : Lacerations : A deep cut or tear on the skin Hematomas : Localized collection of blood outside the blood vessels Contusion : Bleeding & swelling inside brain around the area where the head was struck.

7. PENETRATING TRAUMA

8. LACERATIONS HEMATOMAS CONTUSION

9. MECHANISM OF INJURY cont… SKULL FRACTURES: Linear SF : Appear as thin lines on X-Ray & don’t require treatment, they are important only if there is significant underlying brain damage. Depressed SF: May be palpated & are seen on X-Ray. A  Compound fracture  involves a break in, or loss of, skin and splintering of the bone

10. SKULL FRACTURES cont… Comminuted fractures  in which broken bones displace inward Basilar SF: Occur in bones over the base of frontal & temporal lobes. Not observable on X-ray but, manifested as “ Ecchymosis ” around the eyes or behind the ears by leakage of blood or CSF from ears.

11. ECCHYMOSIS

12. MECHANISM OF INJURY cont… BRAIN INJURIES: Concussion : A head trauma that may result in loss of consciousness from 5mins or less & retrograde amnesia there is no break in skull & no damage is visible on CT or MRI scan. Contusion : A contusion is a bleeding bruise to the brain caused by a direct impact to the head.

13. SIGN AND SYMPTOMS CSF or other fluids draining from the ear or nose Blood behind the tympanic membrane Battle’s sign Vision changes & damage of optic nerve Hearing loss Loss of sense of smell Loss of eye movement Nystagmus

14. BATTLE’S SIGN

15. SIGN AND SYMPTOMS cont… Loss of consciousness Retrograde amnesia Post traumatic amnesia Headache Vomiting Seizures Unilateral facial paresis Vertigo

16. DIAGNOSTIC INVESTIGATIONS History collection and physical examination Complete blood count CT SCAN MRI Electroencephalography (EEG) Positron emission tomography X-RAY

17. MANAGEMENT INITIAL MANAGEMENT A : Airway control including cervical spine immobilization with a stiff collar. B : Breathing C : Circulation

18. MANAGEMENT cont… CONTROL OF INTRACRANIAL PRESSURE: Position head up 30º Diuretics: Furosemide , Mannitol Seizure control: Barbiturates CALCIUM CHANNEL BLOCKERS OXYGENATION

19. SURGICAL MANAGEMENT Craniotomy : Bone flap is temporarily removed from the skull to access the brain Craniectomy : Excision into the cranium to cut away a bone flap Cranioplasty : Surgical repair of a defect or deformity of a skull

20. CRANIECTOMY

21. CRANIOPLASTY

22. NURSING DIAGNOSIS Ineffective tissue perfusion (cerebral) Acute pain (headache) related to trauma and cerebral edema Hyperthermia related to loss of cerebral integrative function secondary to possible hypothalamus injury Impaired physical mobility related to decreased LOC and treatment –imposed bed rest

23. NURSING DIAGNOSIS Fluid volume deficit related to decrease LOC and hormonal dysfunction. Risk for injury related to decreased level of consciousness. Knowledge deficit regarding the treatment modalities and current situation. Anxiety related to abrupt change in health status, hospital environment and uncertain future