TRAUMATIC BRAIN INJURY Other Mechanisms

Traumatic Brain Injury • Penetrating trauma- a form of primary injury and

includes the head wounds made by foreign
• An insult to the brain that is capable of producing
bodies and by bone fragments from skull fracture
intellectual, emotional, social and vocational
• Coup-contrecoup Injuries- term used for complex
changes
head injury
• 30 % of cases are fatal
o “coup”- French word which means
• 20 % die of secondary brain injury 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
Secondary Brain Injury base of the frontal and temporal lobes,
manifested as ecchymosis around the eyes and
Includes: behind the ears or by blood or CSF leakage from
• Ischemia from hypoxia and hypotension the ear
• Secondary hemorrhage and;
• Cerebral edema Brain Injuries

• Concussion
Etiology and Risk Factors o head trauma resulting from a blow
Leading causes: • Contusion
• Motor-vehicle accidents o the brain itself is injured or damaged
• Assaults • Diffuse axonal injury
• Falls o most severe form of head injury
• Sports-related trauma because there is no focal lesion to
remove
o involves entire tissue of the brain and
Mechanisms of Injury
occurs at the microscopic level
• Head injuries are caused by a sudden impact
Types of Diffused Axonal Injury
force to the head or inertial forces within the
skull • Mild- Loss of consciousness and 6-24 hours,
• Three Major Mechanisms of Injury: short term disability
• Penetrating injury • Moderate- coma lasting less than 24 hours with
• Diffuse Injuries such as a blow to the skull incomplete recovery on awakening
• Rebound of the cranial contents may result in an • Severe involves primary injury to the brain stem.
area of injury opposite the point of impact Focal Injuries
 • Epidural hematoma(extradural hematoma) • Management of nutrition and gastrointestinal
o forms between the skull and the dura function
mater • Lab tests
• Subdural hematoma • Lowering ICP
o collection of blood in the subdural
space
Surgical Management
• Intracerebral hematoma
o occurs less often than epidural in • Removal of epidural clot by craniotomy
subdural hematomas • Debridement for penetrating wounds
o caused by bleeding directly into the
brain tissue
Nursing Management

Clinical Manifestations • Assessment

• Level of Consciousness
• Skull Fracture
• Vital signs
• CSF and other fluid drainage from the ear or
• Neuro Vital Signs
nose
• Maintaining nutrition
• Evidence of various nerve injuries
• Monitoring intake and output
• Blood behind the tympanic membrane
• Common Nursing Diagnosis
• Raccoon eyes
• Risk for ineffective airway clearance
• Battle’s sign
• Ineffective cerebral tissue perfusion
• Disturbed thought process
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