23 y o. Aam auto vs ped
tarix 13.03.2017 ölçüsü 473 b. #11239
23 y.o. AAM 23 y.o. AAM Auto vs. ped 8/10/08 Dancing on I-35 under the influence of crack cocaine and ETOH. Dancing on I-35 under the influence of crack cocaine and ETOH. Hit by 2 cars > 50mph GCS 12 on arrival , but declined to 4 Eyes 4>1 Verbal 3>1 Motor 5>2 PMH PMH Denies, but GSW (metallic pellets CXR) PSH Social Hx Single, no children, unemployed, unfunded +ETOH, +amphetamines, +cannibis Recently released from jail for drug possession Meds R frontotemporoparietal SDH R frontotemporoparietal SDH Craniectomy EVD Monitor/treat ICP Paraplegia/paresis L2 burst fracture c subluxation L2-L3 T11 lamina/TP fracture T10-L3 posterior fusion when stable PT/OT/ST…rehab 10th & 11th rib fractures 10th & 11th rib fractures R femur fracture Acetabular fracture Mediastinal hematoma Neuro checks/VS q1h Neuro checks/VS q1h ICP monitoring CPP monitoring MAP monitoring Sedation/analgesia Infection prophylaxis Skin care Trauma Trauma Pulmonary/CC Orthopedics ID SW/CM Rehabilitation Rehabilitation Assessment Decreased short term memory Paraparesis Occurs every 15 seconds Occurs every 15 seconds 500,000 annual ED visits Most common causes: MVAs, falls, assaults Males 15-24, elderly > 75 Accounts for 40% of traumatic deaths 1st 1st Primary Injury : initial insult … i.e. from bleedSecondary Injury : delayed injury from hypoxia, ischemia, and release of neurotoxins Secondary Injury : delayed injury from hypoxia, ischemia, and release of neurotoxinsExcitatory amino acids can cause swelling and neuronal death Endogenous opioids cause increased metabolism, using glucose supplies Increased ICP, especially > 40 leads to brain hypoxia, ischemia, hydrocephalus, herniation Hydrocephalus: clotted blood obstructs CSF outflow tracts and absorption of CSF, disrupts blood-brain barrier Concussion Concussion Contusion Epidural hematoma (EDH) Subdural hematoma (SDH) Basilar skull fracture Diffuse axonal injury (DAI) Mild Traumatic Brain Injury: Mild Traumatic Brain Injury: Concussion : brief change in mental status with axonal swellingModerate to Severe Brain Injury: Contusion: “bruising” Fractures : linear,comminuted, depressed, basalarBleeds : epidural, subdural, intracerebralPeriod of LOC < 30 mins with a GCS of 13-15 after this LOC Period of LOC < 30 mins with a GCS of 13-15 after this LOC Alteration in mental status at the time of the event (dazed and confused) Grade I (confusion, no amnesia, no LOC) Grade I (confusion, no amnesia, no LOC) Remove from activity (may return when asymptomatic) 3 concussions in 3 months: no activity that risks head trauma for 3 months Grade II (confusion and amnesia) Remove from activity for day Recheck in 24 hours No activity for 1 week Two grade II concussions in 3 months, no activity for 3 months Grade III (LOC) To ED for CT Symptom free for 2 weeks, then another 30 days Two grade III concussions, no activity for 3 months Somatic symptoms : headache, sleep disturbance, dizziness, vertigo, nausea, fatigue, sensitivity to light or noise Somatic symptoms : headache, sleep disturbance, dizziness, vertigo, nausea, fatigue, sensitivity to light or noiseCognitive : attention, concentration, memory problemsAffective : irritability, depression, anxiety, emotional labilitySmall bleeds Small bleeds Cerebral Edema Deficits are based on lobe involved Linear
95% go to surgery 95% go to surgery Antibitoics for infection Brain tissue is involved Laceration of dural arteries or veins Laceration of dural arteries or veins Classically laceration of middle meningeal artery “Lucid interval” followed by rapid deterioration Acute bleed 60-80% mortality 60-80% mortality Tearing of bridging veins, pial artery, or cortical veins Acute vs chronic Lacerations of vessels in subarachnoid space Lacerations of vessels in subarachnoid space Intraventricular hemorrhage Intraventricular hemorrhage Very severe TBI Poor prognosis Intracerebral hemorrhage Decreased neurologic function is best predictor of brain injury Decreased neurologic function is best predictor of brain injury Pay attention to cranial nerves Labs: CBC, electrolytes, type and screen, tox and ETOH screen Labs: CBC, electrolytes, type and screen, tox and ETOH screen CT Brain CT angiography or cerebral angiography (penetrating) MRI contraindicated if metallic fragments Intubate GCS 8 or less or airway protection issue (Cricothyroidotomy if necessary) Intubate GCS 8 or less or airway protection issue (Cricothyroidotomy if necessary) Maintain BP 90 mmHg systolic C-spine precautions Tetanus prophylaxis Sterile dressing to wounds ICP monitor in patients with GCS < 8 Hyperventilation not routinely recommended Elevate head of bed to 30 degrees Sedation Propofol Barbiturate Induced Coma Contraindicated in hypotension Mannitol Reduces ICP by reducing blood viscosity, improves cerebral blood flow Serum osmolality should not be > 320 Bolus dosing GCS < 15 GCS < 15 Intoxicated Age > 55 or < 2 Amnesia to events Witnessed LOC (> 15 minutes) Repeated vomiting Evidence of basilar skull fracture Inability to recall 3 of 5 objects Coagulopathy Penetrating head injury BP and oxygenation BP and oxygenation Hyperosmolar therapy ICP monitoring CPP Infection prophylaxis DVT prophylaxis http://youtu.be/YQ609Tk-qQI Stem Cell Therapy Stem Cell Therapy Neural/Glial differentiation Neurogenesis Neuroplasticity Improve motor function Improve cognitive function AANN Core Curriculum for Neuroscience Louis, MO. Nursing, 4th Ed. 2004. Saunders. St. AANN Core Curriculum for Neuroscience Louis, MO. Nursing, 4th Ed. 2004. Saunders. St. Davis, F.A. (2001). Taber’s Cyclopedic Medical Dictionary. F.A. Davis, Philadelphia. Greenberg, Mark. (2006). Handbook of Neurosurgery. Greenberg Graphics, Tampa, Florida. Lewis, S., Heitkemper, M., O’Brien, P., Bucher, L. (2007). Medical-Surgical Nursign. Assessment of Management of Medical Problems. Mosby Elsevier, St. Louis, Missouri Silvestri, Linda. (2008). Comprehensive review for the NCLEX-RN Examination. Saunders Elsevier, St. Louis, Missouri. YouTube - Brain Plasticity YouTube - Brain Plasticity Organizational changes caused by experience Formation of new nerve cells Formation of new nerve cells Genetics
“Directed Neuroplasticity” “Directed Neuroplasticity” YouTube - The Brain Fitness Program (1/8) YouTube - The Brain Fitness Program (1/8) Dostları ilə paylaş:
