1. WELCOME

2. GOOD MORNING

3. Traumatic brain injury is any injury
to the head that results in damage
to the brain

4. TYPES OF HEAD INJURY
Cerebral concussion
 a temporary loss of neurologic function with no
apparent structural damage
 In this the period of unconsciousness lasts for few
seconds to few hours
 Dizziness and spots before eyes(seeing stars)
 Temporary confusion
 Patient should be hospitalized overnight for
observation

5. CONTUSION
 Cerebral contusion is a more severe injury in which
the brain is damaged, with possible surface
haemorrhage
 Patient will be unconscious for more than a few
seconds to hours
DIFFUSE AXONAL INJURY
 It is the damage to the axons in the cerebral
hemispheres, corpus callosum and brain
stem

6. INTRA CRANIAL HEMORRHAGE
 Hematoma (collections of blood) that develop within
the cranial vault are the most serious brain injuries

7. EPIDURAL HEMATOMA
After a head injury,blood may collect
in the epidural space between the skull
and dura

8. SUBDURAL HEMATOMA
Collection of blood between the dura and
the brain
Includes acute and sub acute subdural hematoma
(major head injury)
Chronic subdural hematoma(minor head injuries)

9. INCIDENCE AND RISK FACTORS
 Head injury is the leading cause of all trauma
related deaths
 Age
Motor vehicle accidents
Falls(most common in old peoples)
 Gender
males ratio is greater than females
 Lifestyle
alcohol use
lack of using seat belts and helmets

10. ETIOLOGY
 Motor vehicle accidents
 Acts of violence
 Falls
 Gun shots

11. PATHOPHYSIOLOGY

12. PATHOPHYSIOLOGY
Brain suffers traumatic injury
Brain swelling or bleeding increases intra cranial volume
Intra cranial pressure increases
It reduces the blood flow to brain
Cerebral hypoxia and ishemia occurs
ICP continues to rise brain may herniate
Cerebral blood flow ceases

13. CLINICAL MANIFESTATIONS
Clinical manifestations depend on the degree and
location of brain injury and subsequent cerebral
edema
cerebral edema expands brain volume causing neurologic
dysfunction
 Anatomic abnormalities
scalp lacerations,breaks in the skull,
 Level of consciousness
comma
 Cranial nerve dysfunction
pupils are unequal in size ,whether non reactive to light
 Motor dysfunctions
Hemiplegia

14. DIAGNOSTIC
Assesment
1. Obtain results about the circumstances of the
injury from witnesses
2. Patient should be transffered to ICU
3. Perform physical examination to establish
baseline neurologic function
4. Check level of consciousness
5. Check vital signs

15. MEDICAL DIAGNOSIS
 History taking
 Physical examination
 CT scan
 MRI
 Skull x rays

16. CLINICAL MANAGEMENT
 Goals of clinical management
prevent secondary brain injury
provide support to correct surgically
treatable abnormalities

17. NON PHARMACOLOGICAL INTERVENTIONS
 Hyperventilation (abnormal or over breathing)
 Oxygenation
Patient with severe brain injury may need to be
intubated and placed on a ventillator to ensure optimal
cerebral oxygenation
 ABG
 Fluid restriction
restricting fluid intake to half the daily
volume ie 1500 ml helps to decrease brain
volume, thus reducing the ICP

18. PHARMACOLOGICAL INTERVENTIONS
 Mannitol
 Anti epileptic therapy
 Antipyretic therapy
 Anitibiotics
 Pain killers

19. COMPLICATIONS
 Cerebral edema
 Hemorrhage
 Infection
 Seizures
 Pulmonary conditions such as pneumonia,
atelectasis

20. NURSING DIAGNOSIS
 Impaired gas exchange related to decreased level
of conciousness and weakness
 Altered thought process related to head injury
 Impaired physical mobility related to hemiplegia
 Impaired verbal communication related to damage
to language cortex

22. SPINAL INJURIES
 Any damage
,Trauma or
injury to the
spine

23. ETIOLOGY AND RISK FACTORS
 The most common cause of spinal cord injury is
trauma due to
 Automobile accidents
 Falls
 Gunshot wounds
 Knife wounds
 Sporting accidents
 Tumors to spinal cord

24. PATHOPHYSIOLOGY
Due to etiological factors
Damage to spine occurs
Results in ischemia ,hypoxia,edema and
hemorrhagic lesions
Result in destruction of mylins and axons
Finally spine trauma occurs

25. LEVELS OF SPINAL CORD INJURIES
1. Injury to spinal cord occurs when the vertebral
column is displaced mechanically by trauma or
tumours
2. Cervical spine and cord injuries produce
quadriplegia
3. Thoracic and lumbar spinal injuries produce
paraplegia
4. Injuries above the 4 th cervical vertibrae may
cause death because of loss of innervation to the
diaphram and intercoastal muscles
5. Ischemia, edema, and hemorrhage

26. CLINICAL MANIFESTATIONS
A. Clinical manifestations depend on the level and
severity of cord injury
B. Total sensory and motor paralysis
C. Loss of bowel and bladder control resulting in
urinary retension and bladder retension
D. A complete spinal cord leshion can result in
paraplegia(paralysis of lower body) and
quadriplegia(paralysis of all extremities)
E. Acute pain
F. Respiratory dysfunction
G. Bradycardia

27. DIAGNOSTIC STUDIES
 History collection
 Physical examination
 X rays of cervical spine
 CT scan
 MRI scan
 ECG

28. CLINICAL MANAGEMENT
 Immobilisation (cervical collors)
 Oxygenation
 Foleys catheterisation
 Nasogastric tube
 Pain management
 IV narcotics
 Psychological support
 Bedsore care
 corticosteroids(methyl prednisolone)
 Antibiotics

29. COMPLICATIONS
 Deep vein thrombosis
 Respiratory failure
 Respiratory and urinary infections
 Depression

30. NURSING DIAGNOSIS
 Pain related to spinal cord injury
 Self care deficit related to loss of
function secondary to spinal cord
injury
 Impaired mobility related to
paralysis