Acute subdural hematoma
The definition of a traumatic brain injury is damage inflicted to the head/brain due to an external mechanical force, for example falls in elderly people or road traffic accidents in younger people. A standardized approach to assessing the severity of the brain injury is advocated by the means of Glasgow coma scale (GCS). It is the universal classification system and it consists of assessing three categories; Eye, motor and verbal scales. The sum score ranges from 3 to 15. A score of 8 indicates a severe brain injury (Maas et al, 2008). Head injuries are often minor and not life-threatening. Majority of people with minor head injury will not get a subdural hematoma. However, one in three people with severe head injury will. (Willacy, 2011)
In this essay, I will touch on the pathophysiology of acute subdural hematoma, also known as subdural hemorrhage, its signs and symptoms and its treatments, together with the management expected from the nurses.
Pathophysiology
Subdural hematoma (SDH) occurs when a clot of blood develops between the surface of the brain and the dura mater. Veins rupture when a head injury abruptly shocks or shakes the brain. The usual mechanism that produces an acute subdural hematoma is an impact of high velocity to the head. This causes brain tissue to accelerate or decelerate relative to the fixed dural structures, which in turn tears blood vessels. (Meagher, 2013)
“A subdural haematoma can be:
• Acute – the haematoma forms immediately after the initial injury
• Subacute - the haematoma forms up to a week after the initial injury
• Chronic – the haematoma forms over a period of two to three weeks after the initial injury.”
(Meagher, 2013)
The symptoms of an acute subdural hematoma ...
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... the history given by him, he did not lose conscious at all. He sustained a 2cm cut on the temporal area of his head. He felt fine after that and continued his cycle home when he felt a sudden headache and started to feel nauseous.
Mr A could not bring himself to the hospital due to the extreme pain. He called an ambulance and he started to deteriorate en route to the hospital. His GCS score dropped, he started to get confused and then he threw fits.
A CT scan was done in the hospital that showed a white semi-circular mass, just under the surface of his skull. This means that he has a hematoma building up on the right side of his skull.
An emergency craniotomy was scheduled and he was sent straight up to the operating theater immediately. Mr A had an external ventricular catheter (EVD) in-situ post-operation and was sent to the neurosurgical high dependency unit.
The only result from the testing consistent with a brain injury was the abnormal pupil response of the right eye (constriction) (Traumatic brain injury, 2015). The physical effects that could have pointed to a brain injury were the laceration to the right side of the gentleman’s head and the amount of blood loss. The complaints from the patient that may have insisted a brain injury included a severe headache, dizziness, and nausea (Traumatic brain injury, 2015).
Dr. Tagge, the lead surgeon, finally updated the family over two and a half hours later stating that Lewis did well even though he had to reposition the metal bar four times for correct placement (Kumar, 2008; Monk, 2002). Helen reported wondering if Dr. Tagge had realized how much Lewis’ chest depression had deepened since he last saw him a year ago in the office, especially considering he did not lay eyes on Lewis until he was under anesthesia the day of surgery (Kumar, 2008). In the recovery room, Lewis was conscious and alert with good vital signs, listing his pain as a three out of ten (Monk, 2002). Nurses and doctors in the recovery area charted that he had not produced any urine in his catheter despite intravenous hydration (Kumar, 2008; Monk, 2002). Epidural opioid analgesia was administered post-operatively for pain control, but was supplemented every six hours by intravenous Toradol (Ketorolac) (Kumar, 2008; Solidline Media,
Gibb’s model (1988) first describes the event, so my description of the event is: Mr X was admitted to the medical assessment unit (MAU) from the A+E (accident and emergency) department, with a preliminary diagnosis of a T.I.A. (transient ischemic attack) and dysphasia. Ross and Wilson (1996) describe this as, caused by small...
While doing research on how concussions affected the brain, they came upon SIS. SIS raised concern in the sports community, they found that they need to be more cautious with the care and d management of athletes the suffered head injuries. '" occurs when an athlete who has sustained an initial head injury, most often a concussions, then sustains a second head injury before symptoms associated with the first have fully healed (Cantu and Voy 1995).'" Michael Bay was a athlete that got a concussions, shortly after he was hit again while being in practice. Mr. Bay die in a deep coma, after the medical examiner perform the autopsy it was found that Michael cause of death was a massive cerebral edema ( a cerebral edema is "the accumulation of fluid in and resultant swelling of the brain that may be caused by trauma, a tumor, lack of oxygen at high altitudes, or exposure to toxic substances." MedlinePlus). The next one is the intracranial injury, there are four major types of intracranial injuries: epidural hematoma, subdural hematoma, intracranial hematoma, and cerebral contusion. The epidural hematoma is a bleeding that develops between the dura and the cranial bones. Subdural hematoma is also a bleed, but it develops below the dura mater. The intracranial hematoma is a bleed that happens within the brain tissue. And the last one the cerebral contusion is
Did you know, that someone suffers from a brain injury every 21 seconds (Haas)? Children get concussions all the time, and most of the time they go unnoticed. The majority of concussions happen when one is playing a sport such as football, hockey, or lacrosse. Many famous athletes have had their careers, even their lives cut short due to concussions. Brain damage and death can result from serial concussions (Schafer). When one suffers from a concussion, one’s brain needs time to recover physically and mentally. Between 2002 and 2006, statistics showed that 52,000 people died from concussions and about 275,000 were hospitalized (Fundukian). Everyone’s recovery process is different (“Injury and Pain Care”). Although concussions seem minor, they are very serious brain injuries that may result in severe damage to one’s brain.
Thesis: Concussions affect children and adults of all ages causing physical, emotional and metal trauma to a person and their brain.
Rockwell, P.E.,M.D. Director of Anesthesiology, Leonard Hospital, Troy, NY, U.S. Supreme Court, Markle vs. Abele, 72-56, 72-730, 1972. P.11
On October 16th, 1846 the world of surgery changed forever. Taking place in the Ether Dome at Mass General Hospital was the surgical removal of a tumor in a man’s neck. The surgeon was the world renowned Doctor John Warren. Before Doctor Warren could slice into the man’s neck, William TJ Morten, a dentist, ran into the room. He presented a bag filled with a gas called Ether, and swore that he could erase all of the patient’s pain. He had tested this gas on himself, his dog, and his goldfish. Doctor John Warren gave him permission to try out this relatively untested gas on his patient. For the first time in surgical history, the Ether Dome stayed silent throughout the surgery. No screaming, no flailing, and no burly men needed to hold the patient down (Decoding The Void). Soon Doctors all over the world were using general anesthesia, and history was made.
In the case of Mr. B’s, an investigation into the events surrounding to and leading up to his untimely death would be required. Once the problem has been identified and described, data of events are collected and formatted into a timeline. From the events, any problems in the care of the patient which may have contributed to the end result are identified and determined whether they are causative. In appendix A, the timeline of the event is outlined.
The first patient I saw was a 14 month old boy who sustained a non-accidental head injury. He underwent surgery in July that relieved the excess pressure and fluid around his brain, resulting in him becoming a left hemiplegic.
He is admitted to the ward with the chief complain of pain at right lower quadrant of the abdomen for 8 hours prior to his admission.
...p bruises, joint pain and swelling caused by internal bleeding, unexplained and excessive bleeding or bruising, blood in your urine or stool, prolonged bleeding from cuts or injuries or after surgery or tooth extraction, nosebleeds without a known cause, tightness in your joints, unusual bleeding after immunizations, or excessive bleeding after surgery” (Mayo Clinic).
Stocchetti, N., Pagan, F., Calappi, E., Canavesi, K., Beretta, L., Citerio, G., … Colombo, A., (2004). Inaccurate early assessment of neurological severity in head injury. Journal of Neurotrauma, 21(9), 1131-1140. doi:10.1089/neu.2004.21.1131
Blood coagulation is a cascade of events that help heal a cut or damaged tissue; it is part of a host defense mechanism termed hemostasis [1] When a vessel, or damaged tissue is affected, macromolecules called platelets are introduced (Sticky molecules that assist to clot a cut to allow blood to once again pass) – With fibrin and plasma to help heal. Of course, there needs to be no abnormalities, such as temperature. A type of stroke bleeding is termed hemorrhage, caused by trauma. When blood from trauma irritates brain tissues, it causes swelling [2] In order for a blood clot to occur it requires enzymes to activate other enzymes: TF (Tissue Factor) Serine proteases (Enzymes) such as FVII and FV glycoproteins.
Hixon it caused his C3 vertebrae to slide over his C4 vertebrae and caused a "scissor isn't effect