TBI
TBI
TBI
PRE-SERVICE PROGRAM
SEPTEMBER 2022
TYPES OF TBI
1.CONCUSSION
A cerebral concussion is a minor head injury characterised by temporary loss of neurologic function with no
apparent structural damage.
Its a damage to nerves or blood vessels in the brain often caused by an impact to the head.
May or may not cause unconsciousness.
The jarring of the brain may be so slight as to cause only dizziness and spots before the eyes or it may be severe
enough to cause complete loss of consciousness for a few seconds.
2.CEREBRAL CONTUSION
A severe injury in which the brain is bruised resulting in swollen brain tissue.
The patient is unconscious for more than a few seconds or minutes.
The patient may lie motionless, with a faint pulse, shallow respirations and cool pale skin
3.INTRACRANIAL HEMORRHAGE
Its a collection of blood(hematomas)that develops within the cranial vault.
There are three types of these hematomas;
a)INTRACEREBRAL HEMATOMA
This is collection of blood within the brain
b)EPIDURAL HEMATOMA
This is collection of blood between the skull and the dura mater.
c)SUBDURAL HEMATOMA
This is collection of blood between the dura and the arachnoid mater
SIADH
Brain contusion and brain swelling caused by TBI interfere with and disrupt the normal neuroendocrine function
of the hypothalamus and pituitary system, thus forming the syndrome of inappropriate antidiuretic hormone
secretion and triggering central hyponatremia,
DAI
A diffuse axonal injury is caused by shaking or strong rotation of the head by physical forces, such as with a car
crash. Injury occurs because the unmoving brain lags behind the movement of the skull, causing nerve structures
to tear. The tearing of the nerve tissue disrupts the brain's regular communication and chemical processes.
Resuscitation
First priority is to stop any obvious bleeding by Sub fascial gauze pack placement and Manual compression on the
proximal artery. Carefully applied compressive dressing of the entire injured limb can be done.
Fluids: infuse normal saline initially 2L to run as fast as possible through 2 large bore IV lines
Insert urinary catheter and monitor the input and output chart at least 30-50 ml/hour or 0.5/kg/hour of urine flow
Asses by vital signs, pallor, sweating, anxiety ,skin warmth clammy, input and output Blood transfusion must be
considered if the haemoglobin level is less than 7 g/dl and the patient is still bleeding.
Maintain HEAD INJURY OBSERVATION CHART; Monitoring the following in half , hourly or 2 hourly
Continuous monitor of level of consciousness; Best eye opening score, Best verbal response score, Best motor
response
Vital signs-pulse, temperature, blood pressure, respiratory rate
Pupillary reflexes; reaction to light, size of the pupil,
Motor examination of limbs; Spontaneous movement of all the limbs, Paralysis
Monitor danger signs; Severe headache, Vomiting, Convulsions/seizure, Drainage of fluids ear or nose
Give analgesia to relieve pain
Administer tetanus toxoid
Other general care if patient is unconscious; Bladder care , Bowel care, Physiotherapy chest and limbs, Skin care,
Analgesics
Surgical interventions should be carried depending on severity
ICP
Head Position: Raise the head of the bed and maintain the head in midline position at 30 degrees: potential to
improve cerebral blood flow by improving cerebral venous drainage.
Lower cerebral blood volume (CBV) can lower ICP.
Temperature Control: Fever should be avoided as it increases cerebral metabolic demand and affects ICP.
Seizure prophylaxis: Seizures should be avoided as they can also worsen CNS injury by increasing the metabolic
requirement and may potentially increase ICP. Consider administering fosphenytoin at a loading dose of 20mg/kg.
Only use an anticonvulsant when it is necessary, as it may inhibit brain recovery.
Fluid management: The goal is to achieve euvolemia. This will help to maintain adequate cerebral perfusion.
Hypovolemia in head trauma patients is harmful. Isotonic fluid such as normal saline or Ringer Lactate should be
used. Also, avoid hypotonic fluid.
Sedation: Consider sedation as agitation and muscular activity may increase ICP.