Seminar on head injury and spinal cord injury

SEMINAR ON

HEAD INJURYAND

SPINAL CORD INJURY

BY, UMADEVI.K

1ST YEAR MSC NURSINGTHE OXFORD COLLEGE OF NURSING

BANGALORE

HEAD INJURY

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

BASIC ANATOMY

INCIDENCE

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

Types 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

Traumatic Brain Injury (TBI)

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.

CLASSIFICATION(TRAUMATIC BRAIN INJURY)

Epidural hematoma

With an epidural hematoma, the bleeding is located between the dura mater and the skull.

EPIDURAL HEMATOMA

Subdural hematoma

A subdural hematoma is located beneath the dura mater (sub=below), between it and the arachnoid mater

Subarachnoid bleed

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 bleed

Intracerebral bleeding occurs within the brain tissue itself.

Shear injury

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

Edema

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

Skull fracture

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.

ETIOLOGY

FALLS MOTOR VEHICLE CRASHES Penetrating head injuries (BULLET) SPORTS INJURIES ASSAULTS AND VIOLENCE

SYMPTOMS OF A HEAD INJURY

INITIAL SYMPTOMSInitial symptoms may include ;a change in mental status, meaning an alteration in the wakefulness

of the patientThere may be loss of consciousness,

lethargy, and confusion.

MAIN SYMPTOMS

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,IRRITABILITY,AND LETHARGY

OTHER SYMPTOMS 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.

DIAGNOSIS

HISTORY PHYSICAL EXAMINATION(GLASCOW

COMA SCALE) NEUROLOGICAL EXAMINATION CT SCAN,PET X RAYS

GLASGOW COMA SCALE

COMPLICATIONS

BRAIN DEATH(IRREVERSIBLE END OF BRAIN ACTIVITY)

POST TRAUMATIC AMNESIA DEMENTIA (LOSS OF BRAIN FUNCTION) APHASIA TINNITUS MENINGITIS POST TRAUMATIC SIEZURES ATAXIA COMA

IMMEDIATE MANAGEMENT

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.

MEDICATIONS 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

Surgical management

Scalp wounds cleaning & debridemant Elevation of depressed Fractures Craniotomy & evacuation of

Haematoma Cranial decompression for reduction of

ICT Burr hole evacuation

NURSING MANAGEMENT

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

NURSING DIAGNOSIS

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

NURSING INTERVENTIONS

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

PREVENTION

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

PREVENTING HEAD INJURIES IN CHILDREN

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

SPINAL CORD INJURY

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.

BASIC ANATOMY

INCIDENCE

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.

ETIOLOGY

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.

COMMON CAUSES

Motor vehicle accidents Falls Acts of violence Sports and recreation injuries Alcohol Diseases

RISK FACTORS

Being male Being between the ages of 16 and 30 Engaging in risky behavior Having a bone or joint disorder

SIGNS AND SYMPTOMS

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

OTHER SYMPTOMS

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

COMPLICATIONS 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)

TESTS AND DIAGNOSIS

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).

MANAGEMENT

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.

CARE IN EMERGENCY ROOM 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

Ongoing care 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.

MEDICAL MANAGEMENT

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

SURGICAL MANAGEMENT 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

NURSING ASSESMENT

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

NURSING DIAGNOSIS

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

NURSING INTERVENTIONS

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

CONCLUSION

THANK UUUUUUU ALLLL………………..