SCALP INJURY

SKULL INJURY
TRAUMATIC BRAIN INJURY
 TRAUMATIC BRAIN INJURY
Traumatic brain injury (TBI),
also known as head injury, is the
disruption of normal brain
function due to trauma-related
injury resulting in compromised
neurologic function resulting in
focal or diffuse symptoms.
Motor vehicle accidents are the
most common etiology of injury.
 INCIDENCE
 India has the rather unenviable distinction of having the highest rate of head
injury in the world. In India, more than 100,000 lives are lost every year with
over 1 million suffering from serious head injuries.
 WHO Research Predicts :
 80 percent increase in developing countries
 147 percent increase in road traffic accidents (RTA) deaths in India/Rajasthan
 Groups at highest risk for traumatic brain injury are persons age 15 to 24 years
and males, who suffer traumatic brain injury at a rate almost twice that of
females. The very young (under 5) and the very old (over 75) are also at
increased risk.
MONRO-KELLIE HYPOTHESIS
PATHOPHYSIOLOGY
Brain suffers traumatic injury

Brain swelling or bleeding increases intracranial

volume

Rigid cranium allows no room for expansion of

contents so ICP increases
Pressure on blood vessels within the brain causes
blood flow to brain slow

Cerebral hypoxia and ischemia occur

ICP↑↑, brain may herniate which can result into

cessation of cerebral blood flow
CONTUSION
DIFFUSE AXONAL INJURY
INTRACRANIAL
HEMORRHAGE
INTRACEREBRA
L HEMATOMA
BURR HOLE EVACUATION
ASSESSMENT
DIAGNOSTIC EVALUATION
 MANAGEMENT OF TBI
Assessment of A,B,C
Management of increased ICP and cerebral edema.
Supportive care like nutritional support.
Antibiotics.
Surgery to evacuate hematomas
ICP MONITORING
DECREASING CEREBRAL
EDEMA
 COMPLICATIONS
 Infections : systemic and neurologic
 Increased ICP/ hydrocephalus, brain herniation
 Permanent neurologic deficits
 Sympathetic storming
 DEATH
 SYMPATHETIC STORMING
 It is associated with fever, posturing, tachycardia,
hypertension, and diaphoresis. This exaggerated stress
response, known as sympathetic storming, occurs in
15% to 33% of patients with severe traumatic brain
injury who are comatose (score on Glasgow coma scale
[GCS] = 8).
NURSING MANAGEMENT
 Nursing assessment: multisystem assessment
 Monitor laboratory findings and report abnormal values
 Nursing alert
 Nursing diagnosis
 Nursing interventions
 Patient health education and home care
 NURSING ALERT
Regard every patient who has a brain injury as having a
potential spinal cord injury. Cervical collar and spine
precautions should be maintained until spinal fractured has
been ruled out. A significant number of patients are under
the influence of alcohol at the time of injury, which may
mask the nature and severity of the injury.
 NURSING DIAGNOSIS
1. Ineffective Tissue Perfusion (cerebral) related to increased ICP

2. Ineffective Breathing Pattern related to increased ICP or brain stem injury

3. Ineffective airway clearance and impaired gas exchange related to brain injury

4. Deficient fluid volume related to decreased LOC and hormonal dysfunction

5. Imbalanced Nutrition: Less Than Body Requirements related to compromised

neurologic function and stress of injury
6. Risk for Injury related to altered thought processes
 EVALUATION: EXPECTED OUTCOMES

 No signs of increased ICP

 Respirations 24 breaths/minute, regular

 Tube feedings tolerated well without residual

 Oriented to person, place, and time

 Less agitated; side rails maintained

 Family reports using respite care

 CURRENT UPDATES

1. Concussions and other traumatic brain injuries may increase the risk
of developing Alzheimer's disease earlier in life, according to a
study from UT Southwestern's Peter O'Donnell Jr. Brain Institute.
An analysis of more than 2,100 cases found that people who
sustained traumatic brain injury (TBI) with loss of consciousness
greater than five minutes were diagnosed with dementia on average
2 1/2 years earlier than those who had not experienced TBI.