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What is head trauma?
- - any injury to the scalp skull or brain.
- - with any alterations in consciousness.
- - most common causes include: MVA, falls, firearms, sports injuries, and recreational activities.
What are the three critical time periods for mortality with head trauma?
- - Immediately: due massive hemorrhage and shock
- - 2hrs: due to internal bleeding, worsening trauma,and change in LOC
- - 3 weeks: due to multisystem failure
What are the types of head injuries?
- - Scalp Lacerations: external head trauma that bleed profusely.
- - Skull Fractures: can be linear or depressed; simple, commuted or compound; or closed or open.
- - Minor Head Trauma: Concussion (a sudden transient mechanical head injury with disruption of neural activity and change in LOC).
- - Major Head Trauma: Contusion ( the bruising of the brain tissue usually in a focal area, usually associated with a closed head injury), Laceration ( actual tearing of brain tissue usually associated with depressed and open fractures) and Diffuse Axonal Injury ( wide spread axonal damage to the white matter take 12-24hrs to develop)
What are the manifestations of head injuries by location?
- - Frontal: csf rhinorrhea and pneumocranium
- - Orbital: periorbital ecchymosis
- - Temporal: CSF otorrhea, boggy temporal muscle, and battle sign
- - Parietal: deafness, CSF or Brain otorrhea, bulging of the tympanic membrane, facial paralysis, loss of taste, and battle sign.
- - Posterior Fossa: occipital bruising, visual defects, ataxia (rare)
- - Basilar: CSF or brain otorrhea, bulging of Tympanic membrane, battle sign, tinnitus, facial paralysis, gaze deviation and vertigo
what are the complication for head trauma?
- - Epidural: between the dura and the skull
- - Subdural: between the dura matter and the archnoid layer
- - Intracerebral: bleeding of brain tissue
- - headache
- - nausea/vomitng
- - decreased LOC
- -Pupilary changes
What is the nursing management for head trauma?
- Asses: Glasscow Coma Scale and look for CSF leakage (dextrostix or halo sign)
- Diagnosis: alterd tissue perfusion, hyperthermia, sensory/perceptual alteration, pain, impaired mobility, risk of infection, anxiety, and self esteem.
- Planning: reverse the diagnosis given
- - Health Promotion: safety education
- - Acute Intervention: maintain cerebral perfusion and prevent secondary cerebral ischemia
- - Ambulatory and Home Care:
what is a pneumothorax?
- - air the pleural space that causes partial or complete collapse of the lung.
- - Closed ( which is caused by injury from mechanical ventilation, insertion of a subclavian catheter, perforation of the esophogaus, broken ribs, or rupture blebs or bullae)
- - Open ( which occurs when thier is an opening in the chest from a gunshot wound or stab and surgical thorocotomy)
- - Tension( which is caused by with accumlation air that puts tension on the heart and great vessels)
- - Hemothorax
- - Chylothroax
What are the Clinical Manifestation of Pneumothorax?
- - small pneumothorax ( hemo and chylo) have tachycardia and dyspnea
- - large pneumothorax have shallow, rapid respiration, dyspnea, air hunger, and oxygen desaturation.
- - some experience chest pain, absent breath sounds,cough, and mediastinal shift is a medical emergency
What is associated with rib fractures?
- - most commonly occurs with ribs 5- 10
- - clinical manifestation include pain ( especially on exspiration)
- - goal is to decrease the pain to promote good chest expansion
What is associated with flail chest?
- - Results from multiple rib fractures which causes an unstable chest wall
- - During inspiration the fractured portion is sucked in and during expiration it bulges out
- - Patient also may have rapid shallow respiration and tachycardia
- - Initial therapy consist of airway management, adequate ventilation, oxygen therapy, administration of IV fluids, and pain control.
What is cardiac temponade?
- Blood rapidly collects in the pericardial sac, compresses the myocardium and prevents heart from pumping effectively
- S/S-muffled distant heart sounds, hypotension, neck vein distension, increased CVP
- Treatment- pericardiocetesis with surgical repair