Traumatic brain injury: the impact of delays
An attorney asks you to review a case involving a 40-year-old man who fell on a sidewalk and sustained a traumatic brain injury. His CT Scan showed a small right-sided subdural hematoma. He was taken to the ICU and given supportive care including serial neurologic exams.
You receive the records and note that the patient was awake and oriented upon entering the ICU, but became confused overnight and was unable to follow commands by morning. The nurse placed a call to the resident and the patient was taken for a stat head CT scan. The results demonstrated an “extension of the subdural bleed with a midline shift.” Following the scan, the patient developed respiratory distress and was emergently intubated. He was then taken to the operating room for a craniotomy and removal of the blood clot.
Following the procedure, the neurosurgeon placed a monitor to measure the pressure inside the patient’s head. The pressures were labile and the patient’s neurologic exam continued to deteriorate. Unfortunately, the patient became bradycardic, coded and expired. His death came only 72 hours after the initial trauma and he entered the hospital with a normal neurologic exam.
Analysis of traumatic brain injury case
The attorney asks you questions about the nursing care rendered to the patient on the night of his surgery. Did the nurses provide care in a timely fashion? Did they meet the standard of care? What is the standard of care?
In this real example the nurse had actually delayed care. The documentation showed that the nurse’s neurologic exams were inconsistent and that the resident should have been involved much earlier in the patient’s traumatic brain injury care when the neurologic exam changed. The changes were subtle, but still should have been reported.
Seriousness of traumatic brain injury
Traumatic brain injury, or TBI, is the leading cause of death and disability in patients from ages 1 to 44 years. TBI accounts for 1.4 million injuries and 52,000 deaths each year in the United States alone. Caring for TBI is an intricate and dynamic process that continues to evolve, but with its complexity, there are many simple principles that help to limit the damage and restore function.
Today’s critical care nurse is at the forefront of employing many of these techniques. Follow a patient from the point of injury, through the hospital system and on to rehabilitation. Learn how traumatic brain injury occurs, how it is monitored and what techniques the medical team employs to bring a patient back from injury.
Whether you are new to the world of brain injury or an experienced clinician, this brief overview is for you. Come join us for a session that plans to fill your brain and not damage it!
Scott Rajnic is one of our expert presenters in our all new Falls course. Scott is a critical care nurse. Sharpen your skills of analysis of these common types of cases. Get this on dmeand course to watch at your convenience. Sign up here.