Reflection on Mentorship

Considering no two brain injuries are the same, treatment is stipulated accordingly. In the case of mild injury management, it is fairly low maintenance, requiring a lot of rest and over-the-counter pain medicine. However, the patient must be monitored religiously in case of worsening or new symptoms where immediately medical attention is vital. Once cleared by a doctor, the patient steadily returns to their normal schedules. Immediately after moderate and severe injuries, treatment is concentrated on prevention of secondary damage resulting from inflammation, bleeding, or reduced oxygen supply to the brain. Medications prescribed to diminish chance of secondary loss include diuretics, anti-seizure drugs, and coma-inducing drugs. Surgery is crucial in removing hematomas (clotted blood), repairing skull fractures, and opening a window in the skull in order to relieve pressure and allow room for swelling. A large part of treatment is rehabilitation. The goal is to get patients back to their normal daily routines. Rehab usually

Millions of individuals worldwide are admitted to an Intensive Care Unit (ICU) yearly after a traumatic, life threatening event. Family members keep a vigilant watch over their loved ones during their most vulnerable periods such as being restrained, sedated, and mechanically ventilated, resulting in anxiety for the family during the critical times of hospitalization and for the patient after discharge because they have no recollection of what occurred during these stressful moments. The majority of the patients admitted to the ICU are very appreciative of the medical staff for assisting them in their journey through the unpredictable days

Colton et al. (2014) research looked at 117 clients who experienced increase intracranial pressure as a result of severe traumatic brain injury. Their research looked at client’s respond to pharmacological interventions and these pharmacological interventions include hypertonic saline, mannitol, propofol, fentanyl, and barbiturate. In their research Colton et al., (2014) found “all treatment resulted in significant intracranial pressure changes after 1 hour or 2 hours except for mannitol and barbiturate administration” (Colton at el., 2014). This finding is significant given that mannitol is used as a first line treatment for management of increased intracranial pressure. The chart below demonstrates how each of these pharmacological interventions decreased intracranial pressure and it allows us to compare each pharmacological intervention to each other. (Colton et al., 2014)

Brain injury is normally thought of in terms of primary and secondary insults. First published in the 1970’s this remains a useful concept as it differentiates between the unavoidable irreversible primary injury and the potentially avoidable secondary one (Adams 1977). Primary brain injury occurs immediately at the time of injury, whereas secondary injury is a cascade of events that contributes to intracranial hypertension resulting in a reduction in cerebral perfusion pressure and ischaemia (Marmarou 1991). The cerebral perfusion pressure (CPP) is determined by the Monro-Kellie hypothesis. In closed head injuries, the skull has a fixed volume and the pressure within it is determined by the equilibrium between the CPP, the mean arterial pressure (MAP) and the intracranial pressure (ICP) using the equation:

The ICP value is essentially determined and significantly influenced by volume equilibrium among the brain (1,100−1,300 cm3), CSF (130¬¬−150 cm3) and blood contained in intracranial vessels (60−80 cm3). Considering the fixed brain volume, the two most important determined factors of ICP are the nearly constant cerebral blood flow based on a wide range of the mean blood pressures .In addition, unbalance between the production of CSF in brain ventricles and its absorption into the dural venous sinuses leads to the abnormal ICP (Mokri 2001, Popovic et al.

Further, moving into disability step, AVPU (Alert, Voice, Pain and Unresponsive) was used to assess his level of consciousness (Jevon 2008). He was alert but appeared confused and complained of a severe headache describes as “being hit on the back of the head with a hammer” with a pain score of 10/10. A severe headache is common problem presenting with Mr Devi’s condition after stroke due to increased intracranial pressure resulting from trauma with oedema or haemorrhage (Gould and Dyer 2011).

There seems to be a demand for family counselors applying crisis intervention and grief counseling in hospital trauma units. This crisis intervention assesses families affected by traumatic brain injury (TBI) and the nature of family counselors working with these individuals. The counseling procedure in the hospital trauma unit and treatment focuses on the incapacitated individual as well as the family system. Jacobson & Butler, shared an example case of an 8-year-old boy, whose name was Tommy. Tommy left severely injured in a car incident. Even though Tommy was wearing his seatbelt, he sustained massive head injuries and trauma to the spinal cord. Due to this TBI he needs a ventilator to help support his breathing. Tommy is the client

The patient was transferred from Advocate Trinity hospital where she was brought to the emergency department from a nursing home. Where she was residing since 01/2015 after suffering a stroke. The nursing home staff observe that the patient had a change in level of consciousness and they called 911. Upon arrival to the Trinity hospital a CT of the head was ordered and it revealed a defused intracranial hemorrhage. The Trinity hospital neurologist decided that it would be in patients’ best interest to be transferred to Christ hospital where the technology is better. Therefore, on admission the patient had another CT done which conform a low-pressure bleeding in the right frontal lobe which had ruptured into the right lateral ventricle. The patient was put on a mechanical ventilator and was unresponsive. A neurological assessments reviled limited movement, the left upper and lower extremity moved to pain. The right lower extremity was withdrawing to pain and sensation and the right upper extremities had move spontaneous movement. The pupil had a brisk response to light and the right and left pupil size was 3mm. The patient had present corneas reflexes left and right eye, and had a present cough. The last vital signs noted were: Temperature 36.9  C, HR 80, RR 15, MAP 80 making patient stable at the time. However, patient prognosis of regaining function was slight due to the size of the hematoma and diffuse impact on the brain tissue. The objective data was not obtained due to the patient being

Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology that primarily affects young, obese women (1,5). In idiopathic intracranial hypertension (IIH) there is raised pressure within the skull (raised intracranial pressure), which puts pressure on the brain. Idiopathic means that the cause of this raised pressure is unknown. The main symptoms are headache and loss of sight (visual loss). It mostly affects women of childbearing age who are overweight or obese. Treatment is aimed at preventing permanent visual loss and includes treatment with medicines. Brain surgery (neurosurgery) may also be used. For many people, a combination of medical and surgical treatment can help to control their symptoms well. This disorder

If, however, despite multiple treatments, the ICP control has failed, a decompressive craniectomy should be performed. A decompressive craniectomy is the surgical removal of a section of the cranial vault, allowing the swollen brain to expand through the bone window to relieve pressure and decrease ICP (Dinsmore, 2013). Despite an effective control of ICP and CBF in TBI patients, a decompressive craniectomy has some disadvantages that can lead to a CSF leak, new subdural or epidural hematoma, seizures, cerebral herniation, and infection. The adverse outcomes were more noticed with lower GCS score and increased age (Algattas & Huang, 2014). According to their study, a decompressive craniectomy had a positive outcome in 50% of patients with severe TBI. On the other hand, the surgery had 26.4% of mortality rate

The brain is the most complex organ in the human body; its mysteries rival the understandings of our solar system and continuously challenge the efforts of neuro physicians and researchers alike. This extraordinary biological structure defines our personality, controls how we move, and regulates our five senses. When the brain suffers an injury, the consequences can be devastating; affecting many important aspects of a person’s life, including permanent disability and untimely death (National Institute for Neurological Disease and Stroke, 2014). The impairment of brain tissue, from an injury or trauma, represents a serious public health problem in the United States, according to the Center for Disease Control (2014).

Non-invasive devices to measure ICP would be of benefit to both space and earth applications of the device, on earth they would be advantageous for the continuous monitoring of patients suffering from hydrocephalus and Idiopathic intracranial hypertension(5), and can also used for those that are susceptible to bleeds and infections.

Your post was very interesting. Karen appears to showing late stages of ICP and this make me wonder how long it took for someone to realize she needed medical attentions. It was said that she is not expected to make it through the night meaning her prognosis is poor. At this point, I agree with the fact that is she does survive, she has suffered a severe brain injury and will never be the same person if not in a vegetative state. Along with the medications you explained, removing a piece of her skull seems to be a necessary intervention at this point. As her ICP continues to rise and significantly affect CPP, mediation may not be enough to return blow flow to the brain. As stated by Nakagawa (2011), a hemicraniotomy can reduce ICP and in some

The major vascular complication associated with ADPKD is the presence of intracranial aneurysms (ICA). ICA are present in about 8% of ADPKD patients and are more prevalent in patients with a family history of ICA. The average age at the time of ICA rupture has been reported to be 40 years which is almost a decade earlier in patients without a family history. Most patients with ICA have normal renal function and up to 30% will have normal blood pressure at the time of rupture.(Pirson, 2010).

Facts 3: There has also been studies that have shown that there is a decrease in blood flow to the cerebellar vermis in the brain