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Who You’ll Hear
Kati Kleber, MSN RN – Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.
Melissa Stafford, BSN RN CCRN SCRN – highly experienced and currently practicing nationally certified neurocritical care nurse.
Elizabeth Mills, BSN RN CCRN – highly experienced neurocritical care nurse, current Stroke Navigator for a Primary Stroke Center.
What You’ll Learn:
- Subdural hematoma
- Epidural hematoma
- Seizure
- Brain Tumors
- CPM
- Diffuse axonal injury
This episode discusses a few disease processes that are typically seen by the neuro ICU nurse as well as a neuro floor. We chat about subdural hematomas, epidural hematomas, seizures, brain tumors, and diffuse axonal injury. And as always, this episode is hosted by three neuro ICU nurses!
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Subdural hematoma
- SHD is not a stroke
- Dura = covering of the brain… blood is under the dura but on top of the brain
- Often a tear in a vein, which results in a slow blood accumulation
- Happens often with elderly; brain atrophies and creates space
- Acute – blood is new, the blood isn’t thin. Quite thick… if it’s large enough they’ll go to the OR for an evacuation
- If it’s older (subacute) 1-2 weeks… but blood thins out and become easier to treat. Some surgeons will do a bedside procedure to remove the clot
Epidural hematoma
- Above the dural layer of the covering the brain
- Typically the result in an artery tear, which results in a very fast accumulation of blood in the epidural space
- Appears quickly, enlarges quickly, and is often a surgical emergency
- Common place is around the temporal bone near the eye… meningeal artery… may not lose consciousness
- Liam Neeson’s wife died of this – here is a short article from Advanced Neurological Associates
- Change in HOB with lots of pressure
Seizure
- Patients with neurological injury are at risk for seizures
- You cannot tell just by looking at a patient that they are having a seizure or not; only the EEG can absolutely confirm that
- Safety and maintaining an airway is of utmost importance
- Must get seizures under control
- Antiepileptic drugs (AED’s)
- Looks like they’re having a seizure, but when you look at an EEG they are not actually having one
- Status epilepticus
- Maybe one long seizure, or multiple seizures with minimal breaks
- Must stop the brain from seizing! Brain electricity is going bananas – rescue drugs and airway protection (intubation) is frequently necessary because they cannot maintain their airway while seizing that frequently
- Subclinical seizures
- Not evident from CT or assessment
Brain tumors
- Many kinds of tumors
- Some are cancer, some are not – must get a biopsy, which is incredibly invasive (craniotomy), to definitively say if it is cancerous or not
- Watch Na+ and for CSF leak (clear fluid out of nose, ear)
- Typically, an incision is made through the nares
- Coughing/sneezing precautions
- Usually benign
- Diabetes Insipidus is something to watch for
- Watch urine output closely
Central Pontine Myelinolysis (CPM)
- Medscape article
- Overcorrection of serum sodium – cannot correct too fast (more than 8-10 in 24 hours)
- Must watch closely when administering hypertonic saline
- Essentially, it’s a stripping of the myelin sheath
- Irreversible
- Can be mild, moderate, severe, and fatal
- This is a big deal!
- You won’t get an alert from the lab for overcorrection unless it is over their threshold for hypernatremia.
- For example, if you correct from 125 to 135 in 24 hours, it won’t alert the lab because technically the 135 is normal. However, this is a HUGE change in 24 hours and concerning for demyelination.
Diffuse axonal injury
- Wikipedia article
- Seen with trauma patients
- The force of traumatic shearing causes this
- Global deficits rather than deficits with a stroke that’s one-sided; most (roughly 90%) never regain consciousness
- Ranges from mild to severe
More resources
- Becoming Nursey
- How I Deal With Seeing Patients Die Frequently – YouTube
- Brene brown’s daring greatly
- Secondary trauma
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