Spinal Cord Injury
TBI
TBI
MNGT ICP
Lets MIX IT UPPP
100

A Spinal Injury in this section of the spinal cord, results in ABSOLUTE need for a ventilator 

C1-C4

100

DX Criteria-

Closed Head Injury:

Closed Skull Fracture:

Open Skull Fx/open head injury:

1: Open Scalp, no open skull 

2:Closed scalp, Open Skull 

3: Open scalp, open skull

100

Glasgow coma scale- 

What are the 3 categories

Scoring- a ___ score means BAD

Eye opening, verbal response, motor response 


LOW

100

Range of ICP

Cushings triad

0 to 10mmHg (15 upper limit of normal)

HTN, Bradycardia, Bradypnea

100

What does a DAI injury usually lead to?

Coma... then death

200

Autonomic Dysreflexia: what is it?

When does it occur? 

Who does it happen to?

S&S


When: up to years after initial injury

Who: Above T6 SC lesions

S&S: Sweating above the injury, severe headache, dramatic increase in BP, Nausea,Congestions and Bradycardia 

200

Concussion Vs. Contusion

Concussion-  is diffuse, temporary loss of neuro function, more severe the s&s-->more severe the concussion 


Contusion- Focal (1 area of brain), MORE SERIOUS, S&S have delayed onset 18-36 hours (stupor, confusion, altered LOC)... INTERVENE EARLY 

200

Complications of Intracranial Hemorrhage

Increased ICP, Dural tears, seizures, Diabetes Insipidus/SIADH, Meningitis, Herniation syndrome (blood pushes one hemi into the other, leading to herniation through spinal cord= death)

200

Medical Treatments for ICP

Mannitol, Hypertonic Saline, Corticosteroids(antiacid/histamines- H2 blockers),

Lower body temp to NORMAL body temp

Inotropes & Vasopressors- for Cardiac support

Sedation- reduces metabolic demand

Barbituates- reduces metabolic demand and provides cerebral protections

FOLEY & I&O's

200

Mannitol-- what is it? how quick does it work? where can it be given?

Osmotic Diuretic, Only given in ICU, ICP can be relieved in 15min


300

Autonomic Dysreflexia Interventions:


Do we label the patient chart Y/N?

SIT THEM UP and determine cause of problem: 

Needle cap, kinked catheter, abdominal distention? Y

Yes: Label the chart to alert future caretakers on risk of this problem being possible in the future.

300

S&S of a Basal Skull Fracture:

Biggest risk of getting ______ from this type of type of fracture. 

CSF Otorrhea; CSF Rhinorrhea; Hemorrhage, Circumoral Bruising (around the eyes) and back of ears (battle signs)

300

Intracranial Hemorrhage- 

Causes: 

S&S:

1- Brain Injury, bullets, stabbings, uncontrolled HTN, aneurysms rupturing, vascular anomalies, tumors

2- headache, possible neuro deficits

300

ICP monitoring management- 

Where does it go?

How clean does it have to be?

cockstop must be in what posistion?

Directly into skull, layer of brain, or brain 

STERILE... 

Off position-- outward 

300

SIADH- Increased ADH= FVO

Causes

TX for SIADH

Interventions

Causes: Pituitary Tumor, TBI, Meds; Vincristine (chemo), phenothiazines (psych), Nicotine

TX: Remove cause, 3% NS, Fluid Restriction (800mL-mild; 500mL-severe), Diuretics (lasix)

Conivaptin- inhibits ADH      Tolvaptan- vasopressing agonist

Declomycin- diminishes responsivness to ADH 

Interventions: VS, Lung sounds, I&O's, daily weights, hyponatremia s&s, neuro status 

400

Medications/Tx (5 things) (3 types of Meds) 

Permanent Pacemaker, Maintain BP with fluids/pressors, Decompress stomach with NG, Straight Cath

 methylprednisone (inflammation)  

Atropine(brady) 

Antispasmodics- Baclofin, Dantrium 

400

Epidural Hematoma-

Patient presentation:

Treatments:

Brief LOC with return of lucid state; then as hematoma expands, increased ICP will suddenly reduce level of consciousness.

TX: Reduce ICP, remove the clot, stop bleeding (burr hole/craniotomy), Mannitol, Diuretics, ET Vent  

ICU monitoring and ICP monitoring 

400

Nursing Interventions for ICP (8 things)-

Positioning- 30* or higher; Manage CSF leak, NO NG TUBE (infection, ICP); initiate enteral feedings after 24hrs, maintain temp of 98.6, Seizure precautions, ensure VTE prophylaxis

Teaching to patient and family- Injury, Orientation to room & equipment

400

Early Signs:

Headaches-come or go?  intensity? what makes it worse?

VS

Early: Changes in LOC, restlessness, confusion, drowsiness (increasing), increased respiratory effort, purposeless movements, weakness, pupillary changes, delayed eye movement, extremity weakness (unilateral or bilateral)

 Headaches: constant, increasing in intensity, aggravated by movement or straining. 

Vital Signs: HTN, bradycardia, decreased RR

400

Diabetes Insipidus- peeing sooo soo much. "High and Dry"

Causes

Tx

Interventions

Central (infection, sx, brain tumor, head trauma) , Renal (kidney injury, lithium) or Dipsogenic (hypothalamus defect)

TX: Desmopressin -- caution in CAD patients 

Chloropropamide(Diabinese)-- r/o hypoglycemia   --- Thiazide diuretics

Prostaglandin Inhib if nephrogenic cause

Inter: early detection Replace ADH,maintain hydration, medical alert bracelet, low sodium diet <3g/day, low protein, 

500

Explain autonomic dysreflexia and how it occurs

Exaggerated neuron response to minima stimuli, produced initial spinal injury/shock

500

Acute Subdural Hematoma- 

Possible Causes:

Patient Presentation: 

Treatments:

1- Anticoags, trauma, aneurysms 

2- s&s develop over 24 hrs, altered LOC, Increased BP, decreased HR/RR--> coma

3- IMMEDIATE craniotomy and control of ICP

500

Chronic Subdural Hematomas: 

How long do they develop?

S&S

TX

1- weeks to months

2- s&s may fluctuate- headache, personality changes, mental deterioration and seizures. 

3- Evacuation of the clot, may be left alone if tx will do more harm than good, d/c of blood thinners if suggest

500

Late Signs:  

VS:

Respiratory:

Neuro Status:

LS: Projectile vomiting, resp and vasomotor changes, hemiplegia, decortication, deceberation, flaccidity 

VS: Increase in systolic pressure, widening pulse pressure, slowing heart rate (Called Cushings reflex), fluctuating pulse (high to low), CUSHINGS TRIAD (HTN,<HR&RR)

Respiratory: Cheyne-Strokes, breathing and arrest 

Neuro Status: loss of brainstem flexes- pupil, gag, corneal, and swallow reflex 

500

SIADH S&S labs VS. DI S&S labs

SIADH- Decrease UO, Increased ICP/Serum osmolality, urine osmolality, stupor/coma, tachy, limp muscles,headache and seizures. 

DI- increased Urine output (>250ml/hr), decreased- serum and urine osmolality, hypotension,tachy, weight loss