N213: Health Differences Across the Life Span 3

N213: Health Differences Across the Lifespan 3 Study Guide Skull: These injuries result from a blow strong enough to crack the skull bone and cause a skull fracture. This injury strongly suggests brain injury and the patient should be monitored for changes in consciousness. There are five types of skull fractures: • Depressed: The skull indents in on the brain with an open wound and exposes the brain • Simple: No bone fragments are present • Linear: The skull fractures, but remains aligned • Basilar: Fracture causes a rip in the brain lining (dura) and CSF fluid leaks; a telltale sign is “Battle’s sign,” which is bruising near the mastoid process • Comminuted: The fracture leaves bone fragments Brain/intracerebral: These are actual internal injuries inside the skull. They can range from a mild concussion to very dangerous swelling inside the brain. There are four types of brain injuries: • Contusion: This happens when there is a blow to the brain that causes bruising on the surface of the brain. There can be swelling and even possiblebleeding. • Concussion: This is caused by a blow to the head and temporary loss of consciousness. Symptoms are nausea, vomiting, dizziness, headache, and emotional changes. • Coup-Contrecoup: The head is struck on one side and causes the brain to “bump” into the other side of the skull. • Brain hemorrhage: This is actual bleeding inside the brain. Epidural is the outside of the lining of the brain, the dura mater. Skull fractures are the most common cause and come with a loss of consciousness after injury. The patient wakes up and is conscious, but needs to be monitored for increased intracranial pressure. Pupils may or may not be fixed and the level of consciousness may drop. Subdural is in between the brain tissue and the dura. This happens when an artery or vein inside the brain tears and blood leads into the subdural space. Acute subdural hematomas form in the first 24 to 48 hours after the injury occurs. Watch for dilated pupils in head injury patients. Surgery may be needed to clear any clotting. Intracerebral is bleeding inside the brain tissue. This is caused by severe high blood pressure or a wound that penetrates the brain. People who fall my experience this type of bleeding, especially elderly people. Increased intracranial pressure: This is swelling in the brain caused by excess cerebral spinal fluid or blood. Since the mature skull is fixed, there is nowhere for excess pressure or fluid to go. This causes pressure against the brain and vessels inside. Brain herniation is the most major complication of untreated increased ICP. When ICP rises above 10mm/hg, the brain receives less oxygen and nutrients and eventually ceases to function.

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