Head Injuries Case Study of Allen NOTE: THERE ARE ANSWERS TO 2 CASE STUDIES HERE. I THINK YOU ONLY GOT ONE IN CLASS!!!!!
What initial measures should be taken?
Airway patency Protect cervical spine Any others?
What type of head trauma do you suspect?
Contusion Concussion Skull fracture
What tests should be ordered?
Skull x-rays CT or MRI of head ABG’s Cervical spine x-rays Basic CMP and CBC
What should the nurse monitor?
LOC VS Bleeding from cut Check O2 sats Watch for loss of clear liquid from nose or ears Battles’s sign Raccoon eyes
What should the nurse discuss with the family?
Parents decide…he is a minor Call chaplain or counselor
What might have happened to Allen?
Could be drug or alcohol usage Most likely a subdural hematoma
What tests should be done?
CT of head Drug screen CBC, BMP, ABG’s
If subdural hematoma, what surgery would be done?
Craniotomy with hemorrhage evacuation
What type of nursing assessment would be done post-op?
Glasgow coma scale VS LOC Watch for drainage of wound or from ears or nose
How would the nurse determine the origin of the clear nasal drainage?
Look for halo or ring Document color, amount and appearance Can test liquid for glucose but not reliable
What type of IV fluids will be administered?
Normal saline or 0.45% normal saline
What medications might be used?
Corticosteroids Mannitol
What other interventions might be performed?
In rehab what issues are most likely to be encountered?
Case Study of Mike Parks
1. Are these blood gases acceptable? What is happening? What ventilator changes?
CO2 is high and pH is low Increase vent rate to get rid of CO2 (hyperventilate) What will high CO2 do?
Relationship between hyperventilation and cerebral blood flow?
Hyperventilation blows off CO2, corrects acidosis and keeps ICP down.
What is the best position for this patient?
HOB up 30 degrees Knees straight Head in alignment
What is large bruise behind the ear indicative of?
Battles’s sign-basilar skull fracture Look for rhinorrhea and otorrhea High risk for infection May develop hematoma
ICP is 25 BP = 90/30 CPP?
CPP=MAP-ICP. MAP=DBP + 1/3 (SBP-DBP) MAP=30+ (90-30) 3
What do you do?
Could cause ischemia Raise MAP and lower ICP Check IV fluids, use of diuretics or dopamine Surgery? HOB and body position good?
Signs of diabetes insipidus?
Very high urinary output