• Share
  • Email
  • Embed
  • Like
  • Save
  • Private Content
Seminar on head injury and spinal cord injury
 

Seminar on head injury and spinal cord injury

on

  • 797 views

 

Statistics

Views

Total Views
797
Views on SlideShare
797
Embed Views
0

Actions

Likes
0
Downloads
25
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Seminar on head injury and spinal cord injury Seminar on head injury and spinal cord injury Presentation Transcript

    • SEMINAR ON HEAD INJURY AND SPINAL CORD INJURY BY, UMADEVI.K 1ST YEAR MSC NURSING THE OXFORD COLLEGE OF NURSING BANGALORE
    •  DEFINITION  A head injury is any trauma that leads to injury of the scalp, skull, or brain. The injuries can range from a minor bump on the skull to serious brain injury.
    • Head injury is the number One Killer in Trauma  25% of all trauma deaths  50% of all deaths from MVC  200,000 people in the world live with the disability caused by these injuries 
    •   Acquired Brain Injury (ABI) Traumatic brain injury(TBI)  Acquired brain injury           An ABI is an injury to the brain that occurs after birth. Many different factors can cause an ABI, including: Anoxic injuries (a prolonged lack of oxygen) Hypoxia (decreased oxygen flow) Epilepsy or other seizure disorders Strokes Brain tumors Cerebral Ischemia (restricted blood flow) Infections, such as encephalitis or meningitis Neurotoxic events (exposure to toxic chemicals or drugs) Hydrocephalus
    •  One of the most common types of ABI is a traumatic brain injury, or TBI. Traumatic brain injury means an acquired injury to the brain caused by external physical force. The injury occurs when a blow to the head or body causes the brain to move rapidly inside the skull. The impact and movement can injure brain cells, nerves and blood vessels.
    •  Epidural hematoma  With an epidural hematoma, the bleeding is located between the dura mater and the skull.
    •  A subdural hematoma is located beneath the dura mater (sub=below), between it and the arachnoid mater
    •  Subarachnoid bleeding occurs in the space beneath the arachnoid layer where the CSF is located. Often there is intense headache and vomiting with subarachnoid bleeding
    •  Intracerebral bleeding occurs within the brain tissue itself.
    •  Sometimes, the damage is due to sheer injury, where there is no obvious bleeding in the brain, but instead the nerve fibers within the brain are stretched or torn
    •  All injuries to the brain may also cause swelling or edema, no different than the swelling that surrounds a bruise on an arm or leg
    •  The bones of the skull are classified as flat bones, meaning that they do not have an inside marrow. It takes a significant amount of force to break the skull, and the skull does not absorb any of that impact. It is often transmitted directly to the brain.
    • FALLS  MOTOR VEHICLE CRASHES  Penetrating head injuries (BULLET)  SPORTS INJURIES  ASSAULTS AND VIOLENCE 
    • INITIAL SYMPTOMS Initial symptoms may include ; a change in mental status, meaning an alteration in the wakefulness of the patient There may be loss of consciousness, lethargy, and confusion.
    • ECCHYMOSIS OVER MASTOID AREA (BATTLE’S SIGN) 
    •  RACOONS S EYES
    • PERSISTENT LOCALISED PAIN(SKULL FRACTURE)  CONCUSSION (TEMPORARY LOSS OF NEUROLOGIC FUNCTION WITH NO STRUCTURAL DAMAGE)  CONTUSION (MODERATE BRAIN INJURY IN WHICH BRAIN IS BRIUSED AND DAMAGED IN SPECIFIC AREA)  POST CONCUSSION SYNDROME SYMPTOMS LIKE HEADACHE,DIZZINESS,ANXIETY,IRRITABILIT Y,AND LETHARGY 
    •             vomiting, difficulty tolerating bright lights, leaking CSF from the ear or nose, bleeding from the ear , speech difficulty, paralysis, difficulty swallowing, and numbness of the body. dizziness, irritability, difficulty concentrating and thinking, and amnesia.
    • HISTORY  PHYSICAL EXAMINATION(GLASCOW COMA SCALE)  NEUROLOGICAL EXAMINATION  CT SCAN,PET  X RAYS 
    •          BRAIN DEATH(IRREVERSIBLE END OF BRAIN ACTIVITY) POST TRAUMATIC AMNESIA DEMENTIA (LOSS OF BRAIN FUNCTION) APHASIA TINNITUS MENINGITIS POST TRAUMATIC SIEZURES ATAXIA COMA
    • Unless the airway is blocked, do not move the person until a medical team arrives and checks for spinal cord injury. Do Hands-Only CPR, if Necessary  If the person is unconscious or not breathing, do ONLY chest compressions.  For an adult, start adult CPR  For a child, start CPR for children.  For Mild or Moderate Head Injuries; To control bleeding, apply clean dressings directly to scalp or facial cuts.  To control swelling, apply ice for 20 to 30 minutes every 2 to 4 hours.  For headache, give over-the-counter acetaminophen. Do not use aspirin, ibuprofen, or other anti-inflammatory drugs, which can increase the risk of bleeding.  
    •                Mannitol 0.25-1g/kg Osmotic agent- dec ICP, maintains CBF,CPP and brain metabolism Dec ICP within 6 hrs. Expands volume, O2 carrying capacity. Furosemide To reduce ICT in conjunction with mannitol Dose 0.3 to 0.5 mg/kg Never use in Hypovolemia Barbiturates Effective in reducing ICP – refactory to other measures Not used in presence of hypotension/hypovolemia Phenytoin Loading dose - 18 – 20 mg/kg Maintenance dose - 100 mg q 8 hrly
    • Scalp wounds cleaning & debridemant  Elevation of depressed Fractures  Craniotomy & evacuation of Haematoma  Cranial decompression for reduction of ICT  Burr hole evacuation 
    • ASSESSMENT  Obtain baseline data and immediate health history  Time of injury  Cause of injury  Direction and force of blow  Determine level of consciousness by glasgow coma scale  Check vital signs 
    • Determine ;  ability to respond to verbal commands  pupillary response to light,  status of corneal and gag reflexes and  motor function  Neurological system assesment  Psychological and emotional response  Assesment of whole body system(physical examination)  Assess for hemorrhage 
    • Ineffective airway clearance and impaired gas exchange related to brain injury  Ineffective cerebral tissue perfusion related to increased icp and decreased CPP  Deficient fluid volume related to LOC and hormonal dysfunction 
    • Imbalanced nutrition less than body requirement related to metabolic changes,fluid restriction and inadequate intake  Risk for injury related to siezures,disorientationor brain damage  Potential for impaired skin integrity related to bed rest,hemiparesis ,hemiplegia and immobility  Potential for disturbed sleep pattern related to brain injury and frequent neurologial checks 
    • Monitoring for declining neurologic function  Assessing level of conciousness and its management  Vital signs  Motor function  Maintaining airway  Monitoring fluid and electrolyte balance 
    • Promoting adequate nutrition  Preventing injury  Maintaining body temperature  Maintaining skin integrity  Improving cognitive functioning  Preventing sleep pattern disturbance  Monitoring and managing potential complications 
    •            Seat belts and airbags Alcohol and drug use Helmets Preventing falls for older adults around the house: Install handrails in bathrooms Put a nonslip mat in the bathtub or shower Install handrails on both sides of staircases Improve lighting in the home Keep stairs and floors clear of clutter Get regular vision checkups Get regular exercise
    • The following tips can help children avoid head injuries:  Install safety gates at the top of stairs  Keep stairs clear of clutter  Install window guards to prevent falls  Put a nonslip mat in the bathtub or shower  Don't let children play on fire escapes or balconies
    • A spinal cord injury damage to any part of the spinal cord or nerves at the end of the spinal canal often causes permanent changes in strength, sensation and other body functions below the site of the injury.
    • Primarily in young males (> 75% of cases) and Half of these injuries result from MVAs.  2/3 of patients with spinal cord injury are < 30 years old.  Most common vertebrae involved are C5, C6, C7, T12, and L1 because they have the greatest ROM. 
    • Traumatic spinal cord injury  May stem from a sudden, traumatic blow to spine that fractures, dislocates, crushes or compresses one or more of your vertebrae.  It also may result from  a gunshot or knife wound that penetrates and cuts spinal cord. 
    • A nontraumatic spinal cord injury may be caused by,  Arthritis  Cancer  Inflammation  Infections or  Disk degeneration of the spine. 
    • Motor vehicle accidents  Falls  Acts of violence  Sports and recreation injuries  Alcohol  Diseases 
    • Being male  Being between the ages of 16 and 30  Engaging in risky behavior  Having a bone or joint disorder 
    •         Emergency signs and symptoms of spinal cord injury after an accident may include: Extreme back pain or pressure in your neck, head or back Weakness, incoordination or paralysis in any part of your body Numbness, tingling or loss of sensation in your hands, fingers, feet or toes Loss of bladder or bowel control Difficulty with balance and walking Impaired breathing after injury An oddly positioned or twisted neck or back
    •        Loss of movement Loss of sensation, including the ability to feel heat, cold and touch Loss of bowel or bladder control Exaggerated reflex activities or spasms Changes in sexual function, sexual sensitivity and fertility Pain or an intense stinging sensation caused by damage to the nerve fibers in your spinal cord Difficulty breathing, coughing or clearing secretions from your lungs
    • Areas often affected include:  Bladder control(Changes in bladder control;UTI)  Bowel control  Skin sensation  Circulatory control(AUTONOMIC HYPERREFLEXIA)  Respiratory system(PNEMONIA)  Muscle tone(SPACICITY AND FLACICITY)  Fitness and wellness(WEIGHT LOSS AND MUSCLE ATROPHY)  Sexual health(fertility)
    • History  Physical examination (inspection, testing for sensory function and movement, and asking some questions about the accident, neurological examination)  X-rays  Computerized tomography (CT) scan  Magnetic resonance imaging (MRI). 
    •       EMERGENCY ACTIONS Don't move the injured person permanent paralysis and other serious complications may result. Call your local emergency medical assistance number. Keep the person still. Place heavy towels on both sides of the neck or hold the head and neck to prevent them from moving, until emergency care arrives. Provide basic first aid, such as stopping any bleeding and making the person comfortable, without moving the head or neck.
    •           Maintaining breath Preventing shock Immobilizing neck to prevent further spinal cord damage Avoiding possible complications Medications Methylprednisolone (Medrol) is a treatment option for an acute spinal cord injury Immobilization Traction is needed to stabilize spine, to bring the spine into proper alignment or both. Surgery. Often, surgery is necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae that appear to be compressing the spine
    • After the initial injury or disease stabilizes, doctors turn their attention to preventing secondary problems that may arise, such as deconditioning, muscle contractures, pressure ulcers, bowel and bladder issues, respiratory infections, and blood clots.  The length of hospitalization depends on condition and the medical issues PT facing. Once PT IS well enough to participate in therapies and treatment, May transfer to a rehabilitation facility.
    • High dose corticosteroids (Methylprednisolone) - improves the prognosis and decreases disability if initiated within 8 hours of injury. Patient receives a loading dose and then a continuous drip.  High dose steroids, Mannitol, Dextran  Naloxone - has shown promise in use on humans, minimal side effects, may promote neurological improvement 
    •  Diskectomy - removal of herniated or extruded fragments of intervertebral disc.  Laminectomy - removal of the lamina to expose the neural elements in the spinal canal; allows the surgeon to inspect the spinal cord, identify and remove tissue for pathology, and relieve compression of the cord and roots.  Laminotomy - division of the lamina of a vertebra  Diskectomy with fusion - a bone graft (from iliac crest or bone bank) is used to fuse the vertebral spinous processes; the object of spinal fusion is to bridge over the defective disc to stabilize the spine and reduce the rate of recurrence.
    • FIXATION AND FUSION  Fixation involves stabilizing vertebral fractures with wires, plates, and other types of hardware.  REDUCTION  With reduction, the spine is realigned through the application of a skeletal traction devise, such as Gardner-Wells tongs or Halo traction. 
    • NURSING MANGEMENT
    • Obseve breath pattern  Strength of cough is assessed  Lungs is auscultated  Closely assessed for the symptoms of progressive neurologic damage  Motor and sensory functions are assessed through neurological examination 
    • Monitoring temperature  Lower abdomen is palpated for signs of urinary retension 
    • Ineffective airway clearance relatedto Weakness of intercoastal muscles  Impaired physical mobility related to motor and sensory impairment  Disturbed sensory perception related to motor and sensory impairment  Risk for impaired skin integrity related to immobility and sensory loss 
    • Urinary retension related to inability to void Constipation related to presence of atonic bowel as a result of autonomic disruption Acute pain and discomfort related to treatment and prolonged immobility
    • Promoting adequate breathing and airway clearence  Improving mobility  Promoting adaptation to sensory and perceptual alterations  Maintaining skin integrity  Maintaining urinary elumination  Improving bowel function  Providing comfort measures 
    • Monitoring and managing potential complications  Like ;  Thrombophlebilitis  Orthostatic hypotension  Autonomic dysreflexia  Promoting home and community based care 
    •  THANK UUUUUUU ALLLL………………..