The Student with a Brain Injury: Achieving Goals for Higher Education | BrainLine
A traumatic brain injury, or TBI, can cause speech, language, thinking, and It can happen when an object goes through the skull and into the brain. You may have trouble with attention, memory, and problem solving. Higher The SLP can also test your social skills and see how aware you are of the problems you have. Patients with moderate or severe brain injury should be managed in a . for patients unable to maintain their own airway or achieve a target forumla . For most patients an isotonic fluid such as normal saline is suitable. If a head injury causes a mild traumatic brain injury, long-term problems are rare. Advertising revenue supports our not-for-profit mission.
Avoid talking in the presence of a patient who is in a coma or low level cognitive state; it is not known how much the patient can hear.
Use body language to convey attention and respect. For example, sit with families rather than standing over them.Understanding Traumatic Brain Injury
If families have difficulty understanding English, obtain a professional medical interpreter. Try not to rely on a family volunteer who might misunderstand or have limited command of English. Start with external observations and objective data.
End with clinical implications. Review and repeat information as needed. Give copies of illustrations to explain neuroanatomy.
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- Life with a Brain Injury: Preparing Yourself and Your Family
- Traumatic Brain Injury
Avoid false or premature reassurances as they can confuse families and create mistrust. Summarize information exchanged and decisions made at the end of a meeting with families. Give written information about brain injury, such as pamphlets or fact sheets. Involving Families Treat families as team members with valuable knowledge about the patient prior to the brain injury.
Help families feel confident by acknowledging the accuracy of their observations and their ability to care for the patient. Encourage families to record information using methods that are easy for them to remember, such as audiotapes, note taking or journaling.
Maintain regular communication with the family as a patient progresses. Ask the family to identify one person to be the primary link for communication and know how to contact that person.
Involve families in discharge planning. Supporting Families Ask families about their feelings and give them time to talk about them. Perioperative management should be a seamless continuation of the resuscitation process already begun and an opportunity to correct pre-existing secondary insults.
Communicating with Patients and Families About TBI
Surgery and anaesthesia predispose the patient to additional risks such as hypotension because of blood loss or the effect of anaesthetic agents. Essential monitoring includes ECG, capnography, temperature, and urine output. Invasive arterial pressure allows beat-to-beat monitoring of ABP and regular assessment of arterial blood gases and glucose.
Central venous access may be useful for resuscitation and administration of vasoactive drugs.
The Student with a Brain Injury: Achieving Goals for Higher Education
Despite important differences between the effects of i. They also impair CO2 reactivity. However, at concentrations up to 1 MAC these effects are minimal. Sevoflurane appears to have the best profile. Nitrous oxide is best avoided. However, propofol can cause significant hypotension and reduce CPP.
Critical care management of severe traumatic brain injury in adults
Neuromuscular drugs are recommended to prevent coughing or straining. Patient positioning is usually dictated by surgical access. However, flexion or rotation of the head and the Trendelenberg position may increase ICP in patients with impaired intracranial compliance. Overly tight tracheal tube ties or cervical collars can also obstruct venous drainage. Ventilation should be controlled to maintain oxygenation and normocapnia as confirmed by ABG analysis.
Intraoperative hypotension is associated with a three-fold increase in mortality. As discussed previously, i. There may be a temporary, sometimes severe, decrease in BP after surgical decompression, and administration of vasopressor agents may be necessary to maintain BP and CPP during periods of instability.
Several studies have shown an association between hyperglycaemia and poor neurological outcome in patients with TBI.
The optimal target glycaemic range is yet to be defined but, currently, the literature supports targeting intermediate glucose levels in the range of 6— Over the past twenty years, much has been learned with a remarkable progress in the critical care management of severe TBI.
The second revised edition was published in [ 3 ] with an update inand the 3rd edition was published in [ 4 ]. Several studies have reported the impact of implementation of guidelines-based management protocols for severe TBI on patient's treatment and outcome [ 56 ]. These studies have clearly demonstrated that the implementation of protocols for the management of severe TBI, incorporating recommendations from the guidelines, is associated with substantially better outcomes such as mortality rate, functional outcome scores, length of hospital stay, and costs [ 78 ].
However, there is still considerable and wide institutional variation in the care of patients with severe TBI.
In general, TBI is divided into two discrete periods: The primary brain injury is the physical damage to parenchyma tissue, vessels that occurs during traumatic event, resulting in shearing and compression of the surrounding brain tissue.