Nursing nose bleed memory pictures3/31/2023 Despite education of the public, many young people still lead a lifestyle that predisposes them to head injury. Even those who are discharged often have residual deficits in executive function or neurological deficits. Recovery in most patients can take months or even years. With prolonged hospital stay, there are prone to pressure ulcers, aspiration, sepsis, failure to thrive and deep vein thrombus. Patients with a GCS less than 9 often require mechanical ventilation, tracheostomy, and a feeding tube. Other negative prognostic factors include advanced age, elevated intracranial pressure, and presence of a gross neurologic deficit on presentation. Data indicates that those patients with an initial GCS of 8 or less have a mortality rate of 30% within 2 weeks of the injury. The outcome of these patients depends on the severity of the head trauma, initial GCS score, and any other organ injury. Most patients require admission and monitoring in an ICU setting. The care of a patient with head trauma is multidisciplinary as almost every organ system is affected. The majority of patients with head trauma are seen in the emergency department and is often associated with other organ injuries as well. Head trauma is a major public health problem accounting for thousands of admissions each year and costing the healthcare system billions of dollars. Sedation: Consider sedation as agitation and muscular activity may increase ICP. Isotonic fluid such as normal saline or Ringer Lactate should be used. Hypovolemia in head trauma patients is harmful. This will help to maintain adequate cerebral perfusion. Only use an anticonvulsant when it is necessary, as it may inhibit brain recovery.įluid management: The goal is to achieve euvolemia. Consider administering fosphenytoin at a loading dose of 20mg/kg. Seizure prophylaxis: Seizures should be avoided as they can also worsen CNS injury by increasing the metabolic requirement and may potentially increase ICP. Temperature Control: Fever should be avoided as it increases cerebral metabolic demand and affects ICP. Lower cerebral blood volume (CBV) can lower 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.
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