CRANIOCEREBRAL TRAUMA

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CRANIOCEREBRAL TRAUMA
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Etiology/Pathophysiology
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HEAD INJURY

• Causes death or serious disability.
• Second most commom cause of neurological
  injuries.
• Major cause of death between ages 1 and 35.
• Include motor vehicles and motorcycle
  accidents,falls, industrial accidents, assaults,
  and sports trauma.

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• Injuries vary from minor scalp wounds to
  concussions and open fractures of the skull with
  severe damage to the brain.
• May result in injury to the scalp, skull, and
  brain tissues.

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Effects of severe head injury

• Cerebral Edema
• Sensory and motor deficits
• Increased intracranial pressure

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Injuries to the brain can result from Direct or
Indirect trauma to the head

• Indirect trauma is caused by tension strains
  and shearing forces transmitted to the head by
  stretching of the neck.
• Direct trauma occurs when the head is directly
  injured

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Clinical Manifestations
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Open Head Injuries

• Result from skull fractures or penetrating wounds
• A skull fracture may also occur
• Fractures of the base of the skull are more
  serious because of their location near the medulla

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Closed-Head Injuries

• These include concussions, contusions, and
  lacerations
• Laceration of the scalp bleeds profusely
• Hemorrhage resulting from craniocerebral trauma
  may occur in the following sites
• Scalp
• Epidural
• Subdrural
• Intracerbral
• Intraventricular

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Epidural and Subdural Hematomas

• Epidural
• Resulting from arterial bleeding form as blood
  collects rapidly between the dura and the skull
• If lethargy or unconsciousness develops after a
  patient has regained consciousness and epidural
  hematoma may be suspected.

• Subdural
• Venous blood collects below the dura
• Formation is slow because venous pressue is low
• Causes pressure on the brain
• Will displace brain tissue
• May be classified as acute, chronic, or subacute

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Epidural Hematoma
Subdural Hematoma
CT Scans of Subdural Hematomas
Subdural Hematoma
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ASSESSMENT
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Subjective Data
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• It is important to determine
• - how the injury happened
• - whether the patient has headache, nausea,
  or vomitting
• Note abnormal sensations and history of a loss of
  consciousness and bleeding from any orifice.

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Objective Data
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• (1) respiratory system
• (2) level of alertness and consciousness
• (3) size and reactivity of the pupils
• Assess
• (1) patients orientation
• (2) motor status
• (3) vital sign
• (4) the presence of bleeding or vomitting
• (5) abnormal speech pattern
• (6) the presence of Battles sign

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Diagnostic Tests

• CT
• MRI
• PET

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Medical Management

• Immediate care toward life-saving measures.
• Maintenance of normal body function until
  recovery is ensured.
• Maintain a patent airway and ensure adequate
  oxygenation.
• Arterial blood gas levels are checked.

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• Medications are used to reduce cerebral edema and
  increased intracranial pressure (common problems
  in patients with head injury)
• Medications include mannitol and dexamethasone
• Codeine and other analgesics that do NOT depress
  the respiratory system
• Avoidance of Hyperthermia due to an increases of
  brain metabolism

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Nursing Interventions
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Prevention of Infection

• The patients ear and nose are checked carefully
  for signs of blood and serous drainage, which
  indicate that the meninges are torn and spinal
  fluid is escaping

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Patient Teaching

• Observation for complications such as drowsiness,
  vomiting, worsening headache or stiff neck,
  seizures, blurred vision, behavioral changes,
  motor problems, and other sensory problems.