The document discusses various types of head injuries including concussion, contusion, and skull fractures, defines terms related to increased intracranial pressure, and outlines management of increased ICP including maintaining normal body temperature, administering medications to decrease ICP, and avoiding activities that could raise ICP like turning or suctioning.

5. LOBES OF THE BRAIN

8. ACCELERATION-DECELERATION:-
The rapid changes in velocity of the brain with
in the cranial vault along a straight line from forward
movement to an abrupt stop.
ROTATION:-
Angular acceleration-deceleration of the brain.
TERMINOLOGY

9. COUP INJURY:-
A focal cerebral injury directly under the
area of impact is called a coup injury.
COUNTERCOUP INJURY:-
A focal cerebral injury sustained to the
opposite pole of direct impact

10. HALO SIGN:-
The appearance of blood encircled by a
yellowish stain on the dressing or bed linen is called
halo sign.
CEREBRAL CONCUSSION:-
It is defined as a transient temporary
,neurogenic dysfunction caused by mechanical force
to the brain

11. CEREBRAL CONTUSION:-
A cerebral contusion is a bruising of
the surface of the brain.

12.  Head injury refers to any injury to the scalp, skull
or brain.
 The terms head injury and cranio cerebral trauma is
an insult to the brain that is capable of producing
physical, intellectual emotional ,social and
vocational changes.

17.  Direct blows also result in acceleration deceleration
injuries with diffuse cerebral injury without
concurrent skull injury.
 It can produce strains on cerebral tissue that result in
injury. The strains are compression, tension and
shearing.

18.  Angular acceleration-deceleration of the brain.

26.  It includes concussion and diffuse axonal injuries
CONCUSSION
 It is classified as mild or classic.
 Mild is defined as temporary neurological
dysfunction without loss of consciousness
 Classic includes temporary neurological
dysfunction, unconsciousness & memory loss.

27. DEFINITION
 It is a widespread axonal damage occuring after a
mild, moderate or severe traumatic brain injury. The
damage occurs primarily around the axons in
subcortical white matter of cerebral hemispheres,
basal ganglia, thalamus & brainstem.

31.  DEFINITION
 It is a bruising of the surface of the brain. It may
occur from blunt trauma , penetrating wounds or
acceleration- deceleration closed injuries.
 It may be coup or counter coup depending on the
degree of acceleration – deceleration.

33.  It refers to be a traumatic tearing of the cortical
surface of the brain.
 Usually it is similar like a contusion

34. DEFINITION
 Hemorrhage can occur beneath the fracture or from
an acceleration – deceleration injury in which there
is shearing of the bridging veins or cortical artery.

41. FRONTAL SKULL FRACTURE:
 CSF rhinorrhoea & pneumocranium.
ORBITAL SKULL FRACTURE – periorbital
ecchymosis.
TEMPORAL SKULL FRACTURE:
 Battle’s sign & ottorrhea.
PARIETAL SKULL FRACTURE:
 Deafness , ottorrhea, bulging of tympanic
membrane , facial paralysis, loss of taste & battle’s
sign.

43. BASILLAR SKULL FRACTURE:
 CSF or brain ottorrhea, tinnitus or hearing
difficulties, facial paralysis, vertigo & halo sign.
CONCUSSION:
 Headache, dizziness, lethargy, irritability, inability
to concentrate, memory loss & vomiting.
TEMPORAL LOBE CONTUSION:
 Agitation, confusion & remain alert.

44.  FRONTAL LOBE CONTUSION:
 Alert & hemiparesis.
 BRAIN STEM CONTUSION:
 Unresponsive or partially comatose, rapid
respiration, loss of normal eye movement and small
, equal & reactive pupils.
 INCREASED ICP:
 Early findings:
 Deterioration in the level of consciousness.
 Pupillary dysfunction.

45.  motor weakness
 sensory deficit
 headache
 possible seizure
later findings:
 Cushing triad
 possible vomiting
 possible papilledema
 hemiplegia, decortication or decerebration
 changes in vital signs

47. EMERGENCY MANAGEMENT:
 It includes initial management & ongoing monitoring.
INITIAL MANAGEMENT:
 Ensure patent airway.
 Stabilize cervical spine.
 Administer oxygen.
 Administer IV fluids.
 Control external bleeding with sterile pressure dressing.
 Assess for rhinorrhoea, ottorrhea & scalp wounds.
 Remove patients clothing.

49. INITIAL RESUSCITATION
AIRWAY
Clear tongue, debris, vomit, dentures
Keep C. Spine in line with body by applying a cervical collar
Insert oral airway
If oro–facial injuries compromise airway intubate & ventilate
BREATHING
SPONTANEOUSLY NOT SPONTANEOUSLY
Look for chest injuries: Oxygenate witb bag & mask
flail chest / pneumothorax & call Anaesthetis
Airway unptotected or
or obstructed
Airway Protected
Pa 02 < 95mm Hg
02 saturation < 95%
Pa 02 > 95mm Hg INTUBATE & VENTILATE
CIRCULATION

50.  Monitor vital signs,GCS.
 Monitor eyes size, shape, reaction & anaisogoria
 Assess the response to painful stimuli.
 Monitor the client status.
 Assess the need for intubation.
 Assess the muscle strength.
 Monitor for ventilator support.

51.  Pain & anxiety management.
 Seizure management.
 Hyperthermia management.
 Diuretic therapy.
 Fluid management.
 Drug therapy.
 Neuromuscular blockade.
 Hyperventilation
 ?Steroids.
 Gastric prophylaxis & bowel management.

52.  F-Feeding
 A- Analgesics
 S- Sedatives
 T- Thromboprophylactic
 H-Head elevation,hyperthermia
management
 U- Ulcer prevention
 G- Glycemic control

53.  Elevate the head of the bed to 30 degree.
 Maintain the patient head & neck in neutral
alignment.
 Initiate measures to prevent the valsalva
maneuver.
 Administer medication prescribed to decrease
ICP.
 Maintain normal body temperature.

54. Keep neck mid-line and elevate head of bed …. To what degree?
Dicarlo in ALL-NET Pediatric Critical Care Textbook
www.med.ub.es/All-
Net/english/neuropage/protect/icp-tx-3.htm
Feldman et al.
(1992) Journal
of
Neurosurgery,
76
March et al.
(1990) Journal
of Neuroscience
Nursing, 22(6)
Parsons &
Wilson (1984)
Nursing
Research, 33(2)

55. 0
2
4
6
8
10
12
14
16
18
20
Before During After
Turning
Suctioning
Bathing
Nursing Activities and ICP
Rising (1993) Journal of Neuroscience
Nursing, 25(5)
ICP

56. 0
2
4
6
8
10
12
14
16
18
20
Before During After
Suctioning
Turning
Nursing Activities and
ICP
Rising (1993) Journal of Neuroscience Nursing,
25(5)
ICP
Bathing

57. Family Contact and ICP
Bruya (1981) Journal of Neuroscience Nursing, 13
Hendrickson (1987) Journal of Neuroscience Nursing, 19(1)
Mitchell (1985) Nursing Administration Quarterly, 9(4)
Treolar (1991) Journal of Neuroscience Nursing, 23(5)
Presence, touch and voice of family / significant
others...
• Does not significantly increase ICP
• Has been demonstrated to decrease ICP

58.  Hyperventilate the patient on mechanical
ventilation- administer oxygen.
 Maintain fluid restriction.
 Avoid noxious stimuli.
 Administer sedation to reduce metabolic
demands.
 Maintain the blood pressure – 140/90 mmhg
 Avoid physical restraint

60.  Indications
 Hemorrhage
 EDH,SDH
 Cerebral aneurysm
 Brain abscess
 Damage to tissues covering the brain
 Pre operative nursing care

61. Client Positioning Following
Craniotomy
1. Removal of a bone flap for decompression
2. Infratentorial Surgery
3. Supratentorial Surgery
4. Posterior fossa surgery

64. 1. Monitor - vital signs & neurological status
- ↓sed LOC ,motor weakness
- aphasia ,visual changes
- personality changes
- ↑sed ICP
- head dressing (drainage sign)
- drain
- electrolyte levels
- dysrhythmias

65. 2.Maintain - mechanical ventilation
- midline neutral position (head)
- 1500 ml fluid restriction
- suction in drain
- I/O chart (Q1H)
- quiet environment
3. Mark the drainage area
4. Measure drain & notify physician (>30-50 ml/shift)
5. Give cool compress (ecchymosis /periorbital edema)