c
 

c

 c


 
 Ô 

‡ damage to the brain resulting from

external mechanical force, such as rapid
acceleration or deceleration, impact, blast
waves, or penetration by a projectile

‡ Usually classified based on severity and

mechanism

‡ fall under the classification of central

nervous system injuries and neurotrauma
 m
m


‡ (TB
 is a leading cause of death for persons under

age 45

‡ Approximately 5 million Americans currently suffer

some form of TB
disability

‡ The leading causes of TB
are motor vehicle

accidents, firearm injuries and falls



Ô 
m
  

‡ occurs when the head accelerates and

then rapidly decelerates or collides with
another object (eg, a wall or dashboard
of a car and brain tissue is damaged

‡ Scalp is intact and there is no

communication between the intradural
contents and the atmosphere
 m



‡ temporary loss of neurologic function with no
apparent structural damage

‡ involves a period of unconsciousness lasting

from a few seconds to a few minutes

‡ jarring of the brain may be so slight as to

cause only dizziness and spots before the
eyes (³seeing stars´, or it may be severe
enough to cause complete loss of
consciousness for a time

‡ postconcussion syndrome - headache,

dizziness, lethargy, irritability, and anxiety

‡ frontal lobe - is affected, the patient may exhibit bizarre irrational

behavior
‡ temporal lobe - can produce temporary amnesia or disorientation




‡ more severe injury in which the brain is bruised,
with possible surface hemorrhage

‡ signs and symptoms depend on the size of the

contusion and the amount of associated
cerebral edema

‡ patient may be aroused with effort but soon

slips back into unconsciousness

‡ patients with severe brain injury may have

abnormal motor function, abnormal eye
movements, and elevated
have poor
outcomes²that is, brain damage, disability, or
death

‡ patient may recover consciousness but pass

into a stage of cerebral irritability
 mm m 

‡ associated with cerebral contusion

‡

 
ÿ occurs under the site of impact with
an object
ÿTypical when a moving object
impacts the stationary head
‡ m


 
ÿ occurs on the side opposite the
area that was impacted
ÿ typical when a moving head strikes
a stationary object
 Ô 

 
‡ involves widespread damage to axons in
the cerebral hemispheres, corpus
callosum, and brain stem

‡ patient has no lucid intervals and

experiences immediate coma, decorticate
and decerebrate posturing and global
cerebral edema

‡ Recovery depends on the severity of the

axonal injury
  
‡ occurs when an object penetrates the
skull, breaches the dura mater, the
outermost membrane of the brain
(penetrating injury, or when blunt
trauma to the head is so severe that it
opens the scalp, skull, and dura to
expose the brain
 
 

‡ Hematomas (collections of blood that develop
within the cranial vault

‡ may be epidural (above the dura, subdural

(below the dura, or intracerebral (within the
brain

‡ ajor symptoms are frequently delayed until

the hematoma is large enough to cause
distortion of the brain and increased

‡ signs and symptoms of cerebral ischemia

resulting from the compression by a hematoma
are variable and depend on the speed with
which vital areas are affected and the area that
is injured
 Ô
 


‡ blood may collect in the epidural (extradural
space between the skull and the dura

‡ from a skull fracture that causes a rupture or

laceration of the middle meningeal artery (runs
between the dura and the skull inferior to a thin
portion of temporal bone

‡ momentary loss of consciousness at the time

of injury, followed by an interval of apparent
recovery (lucid interval

‡ considered an extreme emergency because

marked neurologic deficit or even respiratory
arrest can occur within minutes.
 cÔ
 


‡ collection of blood between the dura and

the brain, a space normally occupied by a
thin cushion of fluid

‡ ore frequently venous in origin due to

the rupture of small blood vessels

‡ may also occur from coagulopathies or

rupture of an aneurysm

m  cÔ
 


‡ associated with major head injury involving
contusion or laceration

‡ symptoms develop over 24 to 48 hours

‡ changes in the level of consciousness

( , pupillary signs, and hemiparesis

‡ ushing¶s triad
 c
m  cÔ
 


‡ result of less severe contusions and head

trauma

‡ manifestations usually appear between 48

hours and 2 weeks after the injury
m m cÔ
 


‡ an develop from seemingly minor head injuries
and are seen most frequently in the elderly

‡ time between injury and onset of symptoms may

be lengthy ( 3 weeks to months
‡ resembles other conditions and may be mistaken
for a stroke

‡ less profuse bleeding and there is compression

of the intracranial contents

‡ Blood within the brain changes in character in 2

to 4 days, becoming thicker and darker

m c
  
 
Ô
 


‡ bleeding into the substance of the brain

‡ commonly seen in head injuries when

force is exerted to the head over a small
area

‡ may also result from systemic

hypertension, bleeding disorders

 
redisposing factors recipitating factors

Traumatic injury

Brain swelling and

bleeding

ompensated by
displacement of SF and
venous blood

ncreased intracranial
volume

Rigid cranium allows no

room for expansion

intracranial pressure
increases

ncrease pressure on blood

vessels
 erebral edema hemorrhage

decompensation ecreased and slowed

blood flow to the brain

Further expansion of
mass erebral hypoxia

Small rise in volume erebral ischemia

Further
ncrease in
infarction

Brain herniation to the brain

stem and pons Stroke

Brain death
 


‡ excessive sleepiness
‡ inattention
‡ difficulty concentrating
‡ impaired memory, faulty judgment,
depression, irritability,
‡ emotional outbursts, disturbed sleep,
diminished libido
‡ difficulty switching between two tasks, and
slowed thinking
Ô
 m 


 

‡ slice the brain radiographically into

slabs
‡ more detail than the AT scan
‡ Uses magnetic fields
‡ etects brain damage as small as 1-
2mm in size
‡ Better in detecting the remnants of old
hemorrhaged blood, called hemosiderin
‡ can detect this myelin degeneration as
white matter hyperintensities
 m m


‡ uses x-rays
‡ AT scan is superior to the R
in
detecting fresh blood in and around the
brain
‡ often repeated to insure that a brain
injury is not becoming more extensive
 

‡ onitors the brain's electrical activity by

means of wires attached to the patient's
scalp
‡
f the patient is awake, any slowing of
electrical activity in a focal area of the
brain may indicate a lesion there
  


‡ ositron emission tomography

‡ inhaling radioactive glucose and placing
the patient's head under a large geiger
counter, one can identify abnormal areas
of the brain that are underutilizing glucose
 

  
 
 
 
 


m
  

m "Altered mental status, restless, confusion, weakness, changes in  ,

speech abnormalities, changes in motor response
m"Tissue erfusion: erebral
m" erebral erfusion romotion
 ! 

‡ ontinually assess for presence of visual, sensory/motor

changes, headache, dizziness, and aboratory results

‡ mlevate head of bed to 30-45 degrees and maintain

head/neck alignment

‡ Administer medications and oxygen as ordered by the 

‡ Avoid measures that may trigger increase in
s/a
straining, strenuous coughing, flexing the neck
‡
dentify necessary changes in lifestyle to be incorporated in
his As


 
 

m "
guarding behavior, narrowed focus, facial grimace, reports a pain
scale of 6-10 / 10, restless, distracting behavior, increase in B , HR
m"increased comfort level and pain control
m"pain management
 ! 

‡ ontinually assess the

RST of pain and changes in
general condition and vital signs

‡ rovide rest periods to facilitate comfort, sleep, and

relaxation. The patient¶s experiences of pain may become
exaggerated as the result of fatigue.

‡ rovide anticipatory instruction on pain causes, appropriate

prevention, and relief measures

‡Administer pharmacologic treatment as ordered by the 

 Ô
 
 

m




m "

ncreased pulse rate, ecreased skin turgor, ry mucous
membranes, Weakness, hypotension, thirst,
m"hydration
m"fluid resuscitation
 ! 

‡ onitor and document vital signs, skin turgor and mucus

membranes, monitor active fluid loss from wound
drainage and maintain accurate input and output

‡ ocument baseline mental status and monitor for any

changes

‡ Administer medications, parenteral fluids and blood

products as ordered and continuously assess for
circulatory overload
‡ Assist in maintaining proper nutrition and hydration
‡ Risk for injury related to disorientation, restlessness, or
brain damage

‡
mbalanced nutrition, less than body requirements,

related to increased metabolic demands, fluid restriction,
and inadequate intake
 RmFmRm mS
‡ http://www.braininjury.com/injured.html
‡ http://www.braininjury.com/diagnostic.html
‡ http://www.medscape.com/viewarticle/464
563_4