anterograde amnesia
inability to remember circumstances after an incident
Battle sign
discoloration of the mastoid suggesting basilar skull fracture
brainstem
funnel-shaped inferior part of the brain that controls most automatic functions of the body; it is made up of the pons, midbrain, and the medulla, which is the brain's connection to the spinal cord
cerebellum
part of the brain controlling equiplibrium and muscle coordination
cerebrospinal fluid
clear fluid that surrounds and cushions the brain and the spinal cord
cerebrum
largest part of the brain, responsible for most conscious and sensory functions, the emotions, and the personality
concussion
temporary loss of brain function
consensual reflex
same or similar reaction of the unstimulated pupil when the other pupil is stimulated as when a light is shined into one pupil and both pupils contract
contusion
closed injury to the cells and blood vessels contained within the dermis that is characterized by discoloration, swelling, and pain; a bruise; bruising or swelling of the brain
Cushing reflex
a protective reflex by the body to maintain perfusion of the brain in a head-injured patient with increased intracranial pressure; systolic BP increases, HR decreases, and the respiratory pattern changes
diplopia
double vision
epidural hematoma
bleeding between the dura mater and the skull
extension posturing
a posture in which the patient archers the back and extends the arms straight out parallel to the body; a sign of serious head injury
flexion posturing
a posture in which the patient arches the back and flexes the arms inward toward the chest; sign of serious head injury
brain herniation
protrusion, or pushing, of a portion of the brain through the cranial wall or tentorium
laceration
open injury usually caused by forceful impact with a sharp object and characterized by a wound whose edges may be linear or stellate in appearance; a wound that penetrates the brain
meninges
layers of tissue protecting the brain
raccoon sign
discoloration of tissue around the eyes suggestive of basilar skull injury
retrograde amnesia
inability to remember circumstances prior to an incident
subdural hematoma
bleeding between the brain and the dura mater
1. patient is often confused or unresponsive, making assessment difficult
2. head injuries to a patient can occur days or weeks before onset of s/s
3. many head injuries are life-threatening
4. many Pts who survive head injuries suffer permanent disabilit
Explain the importance of recognizing and providing emergency medical care to patients with injuries to the head
epidural bleeding
bleeding that occurs between the dura mater and the skull and involves the brain's outermost arteries; recognized early and treated, this may have no permanent consequences
subdural bleeding
venous bleeding that occurs beneath the dura
subarachnoid hemorrhage
bleeding that occurs between the arachnoid membrane and the surface of the brain; can be fatal in minutes
1. cerebrum
2. cerebellum
3. brainstem
the three anatomical components of the brain
responsible for most conscious and sensory functions, the emotions, and the personality
functions of the cerebrum
controls equilibrium and coordinates muscle activity; controls muscle movement and coordination and predicts when to stop movement and coordinates the reflexes that maintain posture and equilibrium
functions of the cerebellum
controls most automatic functions of the body, including cardiac, respiratory, vasomotor, and other functions vital to life; all messages between the brain and the spinal cord pass through the medulla
functions of the brainstem
1. scalp has a rich blood supply so injuries of the scalp tend to bleed very heavily
2. underlying fascia may be torn while the skin stays intact, slowing blood to fill the area and either cause you to identify a depressed skull fracture that is not reall
explain the pathophysiology and key s/s of scalp lacerations
1. depressed skull fractures ma pose harm if the bone ends damage brain tissue
2. open wound allows for possibility that bacteria and other contaminants will enter the skull and infect the brain
3. basilar fractures often cause leakage of CSF from ears, n
explain the pathophysiology and key s/s of skull fractures
mild shearing, tearing and stretching of the nerve fibers (diffuse axonal injury) causes some disturbance in brain function; s/s include:
1. presents with AMS that progressively improves; may lose consciousness immediately following impact
2. momentary co
explain the pathophysiology and key s/s of cerebral concussion and diffuse axonal injury
causes bleeding into surrounding tissues and may or may not cause increased intracranial pressure; usually caused by coup/contrecoup or acceleration/deceleration injury; can lead to swelling of brain tissue and can result in permanent disability or death;
explain the pathophysiology and key s/s of cerebral contusion
typically due to low pressure venous bleeding from small bridging veins that are torn during impact to the head; bleeding occurs above the brain; injury may be caused by pressure that is applied to the brain tissue from the formation of the hematoma and i
explain the pathophysiology and key s/s of subdural hematomas
permanent injury that occurs when an object penetrates the skull and lacerates the brain; permanent injury almost always resulting in bleeding and can cause massive disruption of the nervous system; s/s include increase in BP and decrease in pulse rate; s
explain the pathophysiology and key s/s of cerebral laceration
linear skull fracture
most common type of skull fracture that resembles a line and can only be diagnosed through a radiograph because there is no gross deformity
closed skull fracture
injury in which the skull is fractured but there is no open wound to the overlying scalp
open skull fracture
fracture of the skull with an associated possibility that the bacteria and other contaminants will enter the skull and affect the brain
basilar skull fracture
fracture to the floor or bottom of the cranium; often begins as a linear temporal fracture that extends downward and continues to the base of the skull; often cause leakage of the CSF
depressed skull fracture
occurs when the bone ends are pushed inward toward the brain; may post harm if the bone ends damage the brain tissue
diffuse axonal injury
injury to the brain that results from shearing, tearing, and stretching of nerve fibers
open head injury
head injury that involves a break in the skull as well as a break in the scalp
coup/contrecoup injury
cause of a brain contusion where there is damage at the point of a blow to the head and/or damage on the side opposite the blow as the brain is propelled against the opposite side of the skull
acceleration/deceleration injury
cause of a brain contusion, typical of a car crash, where the head comes to a sudden stop but the brain continues to move back and forth inside the skull, resulting in damage to the brain
accounts for only about 2% of head injuries requiring hospitalization but is extreme emergency; commonly occurs from low-velocity impact or from deceleration injury or deceleration injury; almost always associated with skull fracture; arterial and venous
explain the pathophysiology and key s/s of epidural hematomas
acute subdural hematoma
subdural hematoma with s/s that begin almost immediately after the injury
occult subdural hematoma
subdural hematoma in which bleeding continues over time and the s/s don't become apparent for days to weeks after the injury
anytime a patient has suffered an impact to the head
times that you should suspect a subdural hematoma in a patient
patients with abnormally long blood-clotting time: hemophiliacs, alcoholics, Pts taking anticoagulant drugs
individuals that are particularly susceptible to subdural hematoma
up; down; dropping
In isolated head trauma, a patient's BP may go _____ and the pulse rate _____ (a late finding). If your patient has a subdural or epidural hematoma or a laceration, but his BP is _____, you must consider that he is bleeding somewhere else in his body.
1. hypoxia
2. hypercarbia
3. hypoglycemia (BGL <60 mg/dL)
4. hyperglycemia
5. hyperthermia
6. hypotension (systolic BP <90)
factors that can increase the severity of a traumatic brain injury
establishing and maintaining:
1. a patent airway
2. adequate ventilation
3. adequate oxygenation
4. a systolic BP greater than 90
5. a normal body core temperature
6. a normal blood glucose level
goals of emergency care of a traumatic brain injury patient, regardless of the cause or type:
with a rise in ICP, the brain is eventually compressed and pushed out of its normal position, downward and through the foramen magnum; this compresses the brainstem, destroying vital functions including the heartbeat, respirations, and BP; s/s include:
1.
Describe the pathophysiology and key signs of increased intracranial pressure and brain herniation.
Scene size-up: be alert for signs of unresponsiveness or AMS, especially in trauma patients; don't assume that mental status changes in a trauma Pt are due to drugs or alcohol; look for bleeding form the scalp or face or an apparent MOI
Primary Assessment
Describe the neurological assessment of patients with suspected TBI
Questions that are particularly relevant in cases of head injury:
1. when did the incident occur?
2. what is the chief complaint? is there any pain, tingling, numbness, or paralysis? where? how have symptoms changed since the accident?
3. how did the acci
Discuss the focus of history taking and assessment for patients with injuries to the head
1. AMS
2. decreasing mental status
3. irregular breathing pattern (severe)
4. increasing BP and decreasing pulse (Cushing reflex)
5. obvious signs of injury such as contusions, lacerations, or hematomas to the scalp or deformity to the skull
6. visible da
signs and symptoms of a head injury
1. take standard precautions
2. manual in-line spinal stabilization
3. maintain patent airway, adequate breathing, and oxygenation: jaw-thrust maneuver;, remove foreign bodies from mouth; protect against aspiration by having suction available; administer
Provide emergency treatment to patients with injuries to the head