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Scenario of Traumatic Brain Injury in 45 Year Old May

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Traumatic head Injury is the most common cause of death and disability in the UK (National Institute of Clinical Excellence (NICE), 2014) and is the world’s leading cause of morbidity and mortality of those under the age of 45 (Wilson, 2011). A head injury has an impact in epidemiological and economic terms as well as loss in quality of life (Mar et al. 2011). Approximately 700,000 people per year in England and Wales attend an emergency department for head injury, with almost half being the result of falls (NICE, 2007 & Clinical Knowledge Summary, 2009). The vast majority of patients (90%) will have minor head injuries (Vos et al. 2012) and be discharged, however many patients will need to be admitted for definitive care and …show more content…

This is known as Monro-Kellie hypothesis (Porth, 2011). Severe head injury can affect the compensatory mechanisms resulting in them becoming rapidly exhausted (Deitch & Dayal, 2006) and failing. If Sam was showing symptoms such as confusion, memory loss and reduced ability to move his body this would be indicative of cerebral hypoxia, which could be a result of ICP increasing above 20 mmHg (Brain Trauma Foundation, 2007). If ICP increases and unrelieved, compression of the brainstem could occur, causing Sam to become bradycardia, hypertensive and have a decreased respiratory rate, known as the Cushing’s response. The brain is dependent on blood flow to provide oxygen and nutrients to the neurones and remove waste products. The cerebral blood flow (CBF) is generally constant 700ml/min, approximately 15% of total cardiac output due to the brains ability to autoregulate, by the cerebral arterioles vasoconstricting/vasodilating, in response to cerebral perfusion pressure (CPP) (Porth, 2011). CPP represents the blood pressure gradient across the brain and can be calculated by subtracting ICP from systemic mean arterial pressure (MAP). Normal CPP ranges from 50 – 70mmHg with a CPP below 30mmHG incompatible with life (Adam, 2009). It is when CPP falls below 50mmHG or rises above 150mmHG that autoregulation fails and CBF becomes

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