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Abstract: This case study describes the management of a 54-year-old male who presented to the Hospital of the University of Pennsylvania (HUP) with a traumatic brain injury (TBI) after being assaulted. He underwent an emergent bifrontal decompressive hemicraniectomy for multiple, severe fronted contusions. His postoperative course included monitoring of intracranial pressure, cerebral perfusion pressure, partial pressure of brain oxygen, brain temperature, and medical management based on HUP's established TBI algorithm. This case study explores the potential benefit of combining multimodality monitoring and TBI guidelines in the management of severe TBI.
Traumatic brain injury (TBI) patients require a multidisciplinary approach among all members of the Healthcare team, including physicians, nurses, respiratory therapists, speech therapists, physical/occupational therapists, and nutritionists. This case study demonstrates how a successful outcome can be achieved when a TBI patient is treated under the guidance of an algorithm designed specifically for the management of this population. Our facilty, the Hospital of the University of Pennsylvania (HUP), established a TBI algorithm based on the American Association of Neurologic Surgeons Guidelines for the Management of the Severely Brain Injured Patiettt (Bullock et al., 2000), which incorporates surgical management and multimodality monitoring (MMM). These guidelines help healthcare providers address patients' complex needs while executing the established standard of care.
Once an initial injury to the brain has occurred, the cascade of events that follows includes altered cerebral perfusion, increased intracranial pressure, and cerebral hypoxia, which all increase the risk of ischemia. The goal of MMM is to prevent secondary injury to the fragile brain. Critical care nurses play a pivotal role in the successful management of brain-injured patients. This article presents and discusses the implementation of a TBI algorithm as a guideline for neuroscience nurses in caring for TBI patients.
Background
TBI occurs when a blow, jolt, or penetration to the head damages brain tissue. Severity can range from mild concussion to coma and death. This type of injury is a major public health problem and a common cause of death and disability in the United States. It is estimated that 1.5 million people sustain a TBI each year in the United States, and approximately 50,000 people die from TBI, accounting for one-third of all injury deaths (Centers for Disease Control [CDC], 1996). An...