belstaff italia sqg bjm gxm vnm

yxfbbiedtj · Wysłany: Wto 4:33, 22 Mar 2011

Early brain injury combined with the hernia observation and first aid

107-01 traumatic hernia is a neurosurgical emergency is one of the most serious head injury results, if not timely detection and emergency care, it will rapidly life-threatening, the high mortality and morbidity. Our hospital from January 2002 ~ September 2006, Nursing care of a total of 137 patients with traumatic brain herniation are reported as follows: 1 case of clinical data of 137 cases in this group, 105 cases of male and female in 32 cases. The oldest 87 and the youngest 4 years old on average 47 years. Cure in 47 cases, 56 cases of death, vegetative state 34 cases. 2 observation points 2,1 conscious awareness of changes in ① of the original, the latter gradually moved to the sleepy state or not actively seeking fresh thinking to drink, or not easy to respond, stimulate the need to wake up out loud. ② And then suddenly jump into lethargy anxiety. ③ clear in the original sense of the situation, the emergence of incontinence, is not sensitive to pain stimuli. ④ sustained coma in some patients, or there was progressive deepening of the middle clear. Observation of normal 2,2-pupil pupil diameter 2 ~ 6mm, such as great circle around the light responsive, to be observed at any time after injury, pupil changes, if it is found ranging from large pupil, narrow or dilated, the light insensitive, indicating increased intracranial pressure life-threatening, to quickly ruled out. 2.3 Observation of vital signs measurement time T, P, R, BP, had stable vital signs, such as the sudden appearance of blood pressure, pulse slow, deep and slow breathing with snoring, to be alert to whether there is herniation and take appropriate measures to form . Observation 2.4 If there is physical activity the contralateral limb muscle weakness or paralysis, or disappearance of tendon hyperreflexia, and positive signs such as pathology, accompanied by progressive impairment of consciousness, should immediately review the CT line, and make preoperative preparation. 3 first aid and if preoperative preparation rapid rescue of early hernia, hernia is reversible, so the rescue must race against time. ① rapid intravenous infusion of 20% immediately mannitol 250ml, 20min the losers, if necessary, intravenous furosemide to reduce intracranial pressure, cerebral edema, slowing the progress of hernia, the surgery to win the rescue time. ② high-flow oxygen, keep the airway clear,[link widoczny dla zalogowanych], timely and clear the mouth and nose secretions, apnea were on artificial respiration, the use of stimulants, endotracheal intubation with a doctor to give ventilation. ③ speedy completion of preoperative preparation. Postoperative care 4 4.1.1 4.1 observing closely the changes of vital signs monitoring vital signs of life after surgery,[link widoczny dla zalogowanych], when there is intracranial hematoma, increased intracranial pressure, the performance of slow pulse, blood pressure should promptly report a doctor, immediately review the head CT. 4.1.2 changes in pupil pupil awareness of the change of L larvae to determine the incidence of postoperative intracranial hemorrhage and re-development of great significance. Hematoma after removal of the pupil dilated significantly reduced after surgery if the operative side dilated pupils, light reflex reduced or lost, with disturbance of consciousness, should be alert to the possible existence of secondary intracranial hematoma, if necessary, require reoperation . 4.2 Respiratory care patient supine, raise the head 15o ~ 30. , To one side, to prevent the misuse of gastric contents to attract or aspiration pneumonia from choking, continuous oxygen 2 ~ 4L/rain, plus gentamicin 80000U. Continuous 24h, airway humidification, inhaled daily 2 to 3 times to dilute sputum, 2h help patients turn over every 1 shot back, to prevent lung infections. 4.3.1 4.3 to strengthen basic care with saline, sodium bicarbonate, 2 times the daily oral care,[link widoczny dla zalogowanych], prevention of stomatitis. 4.3.2 strengthen the skin care, turning over every shot back 1 2h, local massage, warm sponge bath,[link widoczny dla zalogowanych], to prevent bedsores. 4.3.3 coma patients after nasal feeding supply of nutrition, should now use the existing service, smaller meals,[link widoczny dla zalogowanych], before nasal suctioning, nasogastric suction after 30rain not within, to prevent nausea and vomiting. 4.3.4 Functional exercise: traumatic brain injury rehabilitation exercises early claim to prevent limb atrophy and joint stiffness, in patients with tracheotomy tube removed after the exercise pronunciation, speak. 4.3.5 discharge guidance: to patients after discharge, should adhere to prescribed medication, and functional exercise, outdoor activities should pay attention to safety, decompressive craniectomy in patients after discharge, 6 months who underwent repair of skull, if the pain discomfort, time to hospital, 1 month later. Review to the hospital to do cranial CT. 【
],[