Wednesday, November 29, 2006


Head injury
Closed or open
Grade I= Mild. Not admitted. Short loss of consciousness.
Grade II= loss of consciousness. Lethargy, confusion, hemi paresis, admitted and require surgery.
Grade III= unable to follow even simple commands. Serious damage. Dilated pupils. Without rapid attention may die.
Concussion.--mechanical force and release enzymes. Contusion--brain bruise. Blunt object like a baseball bat. Hematoma.
Epidural or extradural Hematoma=
arterial blood between the dura and the skull. Pt loss of consciousness and regains it. Vomit. hemi paresis. Pupil changes. all leading to rapid worsening. The Tx is to remove the Hematoma by craniotomy.
Subdural Hematoma.= venous bleeding below the dura. ICP.
Complications of head injury= cerebral edema, DI, SIADH, Stress ulcer from use of steroids. Epilepsy. Meningitis. Hyper/hypothermia.
Mannitol and steroids. Antibiotics.

Craniotomy--supratentorial or infratentorial.
Burr holes--used to remove clots.
Nutrition following head injury
May need TPN…stress and steroids increase catabolism.
Airway. LOC. Pupils. Movement. Sensation. Hand grasps. ICP. Resp changes. VS. headache. Glasgow coma scale.
POST OP Craniotomy care
Resp. Deep breath q 2. NO COUGHING! Neuro checks. Suction. Strict I&O. Seizure precaution. CSF leaks. S&S of meningitis.
Supratentorial--head of bed up 30 degrees. On back or unoperative side.
Infratentorial--FLAT on either side.
Assess for bleeding. GI bleeds, assess for emotional response or knowledge deficit.
Brain death--irreversible loss of brain function. EEG will confirm no activity. Cerebral blood flow studies. MD will determine.
Remember Diabetes Insipidus…caused by a decrease in ADH---increased urine output…anticipate to give VASOPRESSINS….give fluids and lytes.
SIADH--restrict fluids….caused by increase ADH. Volume overload and a decreased urine output.


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