Clinical Assessment Traumatic Brain Injury

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Clinical Assessment Traumatic Brain Injury

• Presented by
• Manuel Ramos

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Level of consciousness
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Two components of consciousness

• Arousal/ alertness depends on RAS
• Cognition complex process involving all mental
  activities, controlled by the cerebral
  hemishperes c

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• Orientation to time is lost initially followed by
  loss of orientation to place then orientation to
  person
• Continuous stimulation is required to maintain
  wakefulness as level of consciousness decreases

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Breathing
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Breathing

• Neural centers in pons and medulla respond to
  changes in arterial levels of oxygen (PaO2) and
  carbon dioxide (PaCo2) which maintains the
  rythmic normal patterns of respiration
• Table 42-3 Breathing Patterns Characteristic of
  Altered Level of Consciousness p. 1348 LeMone
  Burke (2004)

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Area of cerebral damage and respiration patterns

• Diencephalon cheyne-stokes respiration
• Midbrain neurogenic hyperventilation (gt40/min)
• Pons apneustic
• Medulla ataxic/apneic eespiration

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Pupillary and Oculomotor Responses

• Unilateral, dilated (4mm), fixed and nonreactive
  uncal herniation with oculomotor nerve damage,
  brainstem compression, Increased ICP, tentorial
  herniation, head trauma with subdural or epidural
  hematoma
• Bilateral, dilated (4mm), fixed and nonreactive
  severe midbrain damage, hypoxia
• Bilateral, midsize (2mm), fixed and nonreactive
  midbrain involvement caused by edema, hemorrhage,
  infarctions, lacerations, contusions
• Bilateral, pinpoint (lt1mm), and usually
  nonreactive lesion of pons, usually after
  hemorrahge

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• Effects of localized lesion may be initially seen
  in ipsilateral pupil
• Generalized or systemic processes affect both
  pupils equally
• Cranial nerve III compression _at_ midbrain, pupils
  become oval or eccentric
• Progressive deterioration/ functional impairment,
  pupils become fixed and eventually, dilated
• Dolls eye movements are indicators of brainstem
  function

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Motor responses

• Table 42-1 Progression of Deteriorating Brain
  Function p. 1346 LeMone Burke, refer to motor
  responses

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Interventions

• Non surgical Vital signs, positioning,
  hyperventilation, barbiturate coma, drug Rx
• Surgical management craniotomy postoperative
  positioning, dressing, labs, ventilating clients,
  drugs, preventing complications