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Head Trauma

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by

Aubrey Yeager

on 23 September 2013

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Transcript of Head Trauma

Question 1
What is the rationale for use of a long spinal board and a Philadelphia collar?
Differentiate the different types of skull fractures associated with head injuries. How do the clinical manifestations differ?
Question 3
Head Trauma
Discuss the significance of a midline shift. Could this cause changes in the
neurological assessment?
Question 4
List and describe possible secondary injuries with head injury. What nursing management actions are essential to prevent or minimize the effect of secondary injury?
Question 5
Discuss CPP and auto regulation? Discuss the effect hyperventilation has on cerebral blood flow and increased ICP?
Head Trauma
Question 6
What methods are available for monitoring ICP? Describe the potential complications.
What are the legal issues when there is a same sex partnership?
Question 7
Question 8
Describe the relevance of controlling fever in the management of head injury. Review
the clinical practice guidelines on head trauma and temperature management and
explain the relevant interventions to correct the problem.
Group Members:
Conrad Cash
Carolyne Dennis
Nicole Groover
Natalie Johnston
Tanya Nichols
Brittany Schoen
Rachel Shugart
Rebecca Smith
Amber Strong
Aubrey Yeager
Question 2
BP: 90/40 ↓
HR: 100 bpm
Respirations: 40 and labored ↑
Temperature: 36.7°C (98°F)
Glasgow Coma Scale: 9/15
Diagnostic Data:
Radiology Data:
CT of head with left temporal cerebral edema with a midline shift of brain structures
Left temporal parietal subdural hematoma
Left first rib fracture
Post-op Assessment
18 hours post-op
RR: 12 breaths/min
Temp: 37.8°C (100°F)
pH: 7.48↑
PCO2: 40 mm Hg
PO2: 434 mm Hg
HCO3: 20.4 mmol/L ↓
Vt: 500ml
Rate: 12 breaths/min
Fi02:100%
Extubated
Opens eyes to speech
Verbalizes incomprehensible sounds
Abnormal general flexion
Glasgow Coma: 8
Temperature increased to 38.3°C (101°F) in 2 hours
ICP: 26 (↑) & MAP 70 even after hyperventilation therapy
Potassium: 3.9 mmol/L
Sodium: 139 mmol/L
Osmolality 282
Orders
Fluid restriction to maintain osmolality between 305 and 315
Lasix 20 mg
Mannitol 25-50g periodic bolus for ICP greater than 20
Dilantin 100mg
Tylenol 650mg
External cooling blanket to keep patient normothermic
Notify neurosurgery if CPP below 75
ICP remained 12-24 for more than 72 hours
Pressures stabilized
Ventriculostomy clear drainage of 45-60ml per hour
Day 8 drain D/C due to ICP of 10-14
MAP-ICP=CPP
70 - 26 = 44
60-100: Normal CPP
40-60: Hypoperfusion
<40: Anoxia
CPP Values
(Textbook)
Joyce
Protect your brain.
You only have one!
Full transcript