TRAUMATIC

BRAIN
INJURY
Honey Chille N Tolentino RN MAN
Dean, School of Nursing
 Quick Review:
The anatomy and physiology of the brain
The brain is made up of billions of neurons. It also has a
number of specialized parts that are each involved in
important functions.
Understanding these parts can help give a better idea of
how disease and damage may affect the brain and its
ability to function.
MONROE KELLIE DOCTRINE
 TRAUMATIC BRAIN INJURY

Definition 1:
An insult to the brain, not of degenerative or congenital in
nature caused by an external physical force that may produce a
diminished or altered state of consciousness, which results in the
impairment of cognitive abilities or physical functioning. It can
also result in the disturbance of behavioral or emotional
functioning.
 TRAUMATIC BRAIN INJURY

Definition 2:
a ‘disruption in the normal function of the
brain’ typically caused by a sudden, violent
blow or jolt to the head, or in some cases, a
penetrating head injury.
 PATHOPHYSIOLOGY OF HEAD INJURY
Mechanical Injury:
• Motor vehicle collisions
• Assaults
• Falls
Penetrating injury
• Gunshot wounds
• Stabbing
• Explosions
 RISK FACTORS

• Children less than 4 years old

• Young adults between the ages of 15 and 24
• People above 60 years of age
• Gender - men are more prone than women
 HEAD INJURY-PATHOPHYSIOLOGY
Primary injury
Irreversible cellular injury as a direct result of the injury
Prevent the event
Secondary injury
Damage to cells that are not initially injured
Occurs hours to weeks after injury
Prevent hypoxia and ischemia
PRIMARY MECHANICAL INJURY

• injury to axons and blood vessels

results from rotational and
translational accelerations.
• Rotational acceleration causes
diffuse shearing/stretch of axonal
and vascular cell membranes,
increasing their permeability
(“mechanoporation”)
 TWO TYPES OF BRAIN INJURY

• Closed brain injury. Closed brain injuries

happen when there is a nonpenetrating
injury to the brain with no break in the
skull. ...
• Penetrating brain injury. Penetrating, or
open head injuries happen when there is
a break in the skull, such as when a
bullet pierces the brain.
 SKULL FRACTURE
• Basilar Fracture – most
common DX: Ring Sign, glucose
• Dual Tear: CSF Transferrin
• CSF Otorrhea
Prophylactic Antibiotics:
• CSF Rhinorrhea
Ceftriaxone 1-2 gms
• Battle Sign
• Racoon Sign
• Hemotympanum
• Hearing Loss
• Seventh Nerve Palsy
BATTLE SIGN
 SCALP
LACERATIONS

• May lead to massive

blood loss
• Small galeal
lacerations may be left
alone
SKULL FRACTURES
SIGNS AND SYMPTOMS
 OTHER SIGNS AND SYMPTOMS

• Loss of consciousness • Dizziness or fatigue

• Mild to severe headache • Loss of balance

• Nausea or vomiting • Sensory Symptoms

• Blurred vision
• Dilation of pupils
• Double vision
• Loss of coordination
• Ringing sound in ears
• Sleeping disorders
• Loss of ability to smell
• Convulsion
• Sensitivity to light or sound
 POST TRAUMATIC AMNESIA

• Confused
• Disoriented
• Unable to store and receive new information
• Treated with haloperidol and oral resperidone
with benzodiazapine
INTRACRANIAL PRESSURE (ICP)

Intracranial pressure
(ICP) is the pressure
exerted by fluids such as
cerebrospinal fluid (CSF)
inside the skull and on the
brain tissue,

The normal range of ICP is

between 7-15 mmHg for a
supine adult
DIAGNOSTIC : COMPUTED TOMOGRAPHY OR
CT SCAN
 BEFORE CT SCAN

• Patients are advised to wear loose clothing without

zippers or metal clamps so that it will be easier for them
to move around especially if the scan is just for a
particular part of the body.
• Metal objects such as jewelry and belts are required to be
removed to prevent them from interfering with the scan.
 DURING CT SCAN
• Depending on the procedure, patients may be
given contrast or a dye, which makes the
scanned area clearer when examined. This can
be administered via IV, orally, or via enema.
• For the procedure, the patient lies on the bed
of the CT scanner and is then moved into the
gantry where the rotating x-ray detectors are
found. Hearing a buzzing sound during the
procedure is normal. It is advised to stay still
during the procedure so that the images will
not be blurry. It usually takes around 10 to 20
minutes to complete the scan.
 AFTER CT SCAN

• After the scan, the patients can continue on with their

normal routine. There shouldn’t be any pain or side effects
once the procedure has been completed.
• For patients who have been given contrast, they are asked
to remain for an hour to ensure that there is no allergic
reaction to the liquid.
DIAGNOSTIC : MAGNETIC RESONANCE IMAGING OR MRI

Provides precise details of body

parts, especially soft tissues, with
the help of magnetic fields and
radio waves.

Type: Imaging
Duration: Usually 15-90 mins
Results available: Within a month
Conditions it may diagnose:
Stroke · Cirrhosis of the liver ·
Hepatitis · Traumatic brain injury ·
Cancer and more
Is Invasive: Noninvasive
Ability to confirm condition: High
Ability to rule out condition: High
 GOLDEN HOUR

• Traumatic brain injuries require rapid diagnosis. Often, it is

important to begin treatment within the “golden hour”
following injury.
• The golden hour refers to the initial 60 min post-trauma which
are crucial for transferring patients to a trauma
center and initiating of resuscitation
Basic ICP management interventions

•Maintain the neck in neutral alignment: This ensures optimal flow of

CSF out of the skull cavity.

•Raise HOB: Studies show that keeping the HOB at 30-degrees helps
CSF flow adequately to maintain the desired ICP.

•Avoid severe flexion at the hips: Flexion can cause increased intra-
abdominal pressure, which leads to increased intrathoracic pressure
which leads to increased ICP.
•Consider loosening tight C-spine collars (with MD approval):
While C-collars are fantastic for keeping the neck in neutral
alignment, tight collars can impede CSF flow.

•Maintain a normal temperature: ice-packs placed at groin and

axilla, cooling blankets are also used, per MD order. Shivering
increases ICP
 BASIC HEALTH AND SAFETY MEASURES THAT COULD
POTENTIALLY PREVENT A TBI
• Always use a seatbelt when in a car.
• Never drink and drive.
• Get regular exercise.
• Keep stairs and floors clear of clutter.
• Use a helmet when playing sports or riding a bike.
• Install grab bars in a bathroom used by the elderly.
• Use nonslip mats.
• Always get a doctor’s opinion after a blow to the head
 TO DO

• GCS
• Neurovital signs
• NCP
• Turning/ Transferring
• Bed Bath/ Bed shampoo
• Bedsore Precautions
• Pneumonia Precautions
• Assist in Feeding : oral, NGT, PEG
• Assist in suctioning
• Measuring I and O, Draining IFC
• Therapeutic Communication