Traumatic Brain Injury (TBI): Definition and Causes (Nursing)

00:01 Welcome to our video series on the Central Nervous System.

00:04 And this one, I'm going to introduce you to Traumatic Brain Injuries.

00:07 Now, first of all, let's start with a basic definition.

00:10 A head injury is any trauma.

00:13 Okay, so they can range from very mild to severe.

00:16 But we're talking about any trauma to the scalp, the skull, or the brain.

00:21 So the injury might be a minor bump or it could be a serious brain injury.

00:25 So when you hear us talk about head injuries, keep that in mind.

00:29 This could be like a really stressed out mom whose little one fell and bumped their head and they have a scalp laceration or this could be a very serious life-altering brain injury.

00:39 Covers the whole spectrum when we say head injury.

00:42 Now the CDC, that's usually who we go to for definitions, defines a traumatic brain injury as a disruption in the normal function of the brain.

00:53 It can be caused by a bump, blow, or jolt to the head, or even a penetrating head injury.

01:00 Okay, now we're getting more serious.

01:02 And a traumatic brain injury is going to disrupt the normal function of your brain.

01:07 See, that's one of the most difficult things about traumatic brain injuries after they've recovered.

01:12 People may look completely functioning on the outside, but they're not quite right and able to make like high-level executive decisions.

01:21 I had a really good friend whose husband had a traumatic brain injury.

01:25 and it was very difficult after he went home because you couldn't see any scars, you couldn't see any sign of his brain injury, but he would forget things like he'd leave the kids at daycare, or he wouldn't remember where he parked his car, so it was very difficult to kind of work through those things, because it was very frustrating for him as a patient and very difficult for the family.

01:46 So keep in mind, traumatic brain injuries are not just traumatic for the patient, they're also traumatic for the family.

01:53 And they all need a lot of care and counseling as they work through this process.

01:58 But in order for it to be a TBI, we have to have some type of disruption in their normal function of the brain.

02:04 Now there are lots of possible causes of TBI and you guys that are heading for ER, you're going to hear the craziest stories of what people do and what they experience.

02:14 But let's talk about some of the basic ones.

02:16 The causes could be a violent blow or jolt to the head or body.

02:20 There could be an object that penetrates the brain tissue like a bullet, or maybe even their own skull that's been shattered.

02:27 Okay, so when you're thinking about there's got to be some trauma to the head.

02:32 Now it might penetrate, it might not.

02:34 Just the actual bouncing or moving of the head inside your skull, your brain moving around the side your skull can cause a traumatic brain injury, or something can actually go through the skull like a bullet, or if I've suffered a big traumatic blow to my head, pieces of the skull can also damage my brain.

02:52 So, for example, someone's in a motor vehicle accident or they're shot, a firearm-related injury, or they fall and bump their head, and that happens particularly with our elderly patients.

03:04 Now the saddest one is if someone has experienced child abuse, or is may be attacked or beaten up.

03:10 There can be sports-related injuries.

03:12 American football, this has been a huge topic of discussion for football players, American football players and head injuries.

03:20 Also, there's recreational accidents.

03:22 People fall off four-wheelers or they, you know, they can bump into rocks, or they do all kinds of things, a large amount and variety in the recreational accidents category.

03:33 But one thing you can be sure of that any one of these things is an opportunity for a patient to experience a traumatic brain injury.

03:40 We've got a note for you there.

03:42 "Alcohol makes everything worse!" It impairs judgment and really makes it difficult to assess any neuro changes if someone is also intoxicated.

03:54 So, let's start with a question.

03:56 What is the cause of death from a TBI? Now this might sound kind of morbid.

04:02 But as nurses, you have to learn to be always anticipating worst-case scenario for any patient that you see, for any diagnosis that you're interacting with.

04:11 As a nurse your job is think, to know what is the worst possible case scenario, and then watch for any signs, because you want to recognize early.

04:20 What's going on with that patient? When you start seeing early signs, you can intervene and help really advocate and take the best, most safe and effective care of your patient.

04:30 So, that's why you'll hear us ask questions like this: What is the problem with a TBI? What could possibly cause death? Well, if the patient dies initially after the injury, it might be from the direct trauma to the brain tissue, or it could because of a massive hemorrhage and the patient ends up in shock.

04:48 This could be like the brain herniation.

04:51 That means when the brain tissue, there's such pressure inside the skull from swelling or extra bleeding that it causes that brain tissue to shift and squish through the holes in your skull, and you end up cutting off blood supply.

05:05 You can also have hypoxic-ischemic damage.

05:09 That means for whatever reason, the brain did not receive enough oxygen to stay functioning.

05:14 Just like if a patient has a heart attack.

05:17 Because you know the blood supply-- There's something that clots off the blood supply to the heart, so it doesn't get enough oxygen, and that heart tissue dies.

05:26 Same thing can happen in your brain.

05:29 So when you see hypoxic-ischemic damage, that means for whatever reason, oxygenated blood supply was cut off to the brain tissue, and that's what caused death.

05:40 So, if the patient dies pretty close to the time they experience injury, those are usually the most common reasons why the patient would die.

05:47 Now if the patient dies longer after injury, it might be because of multi-system failure.

05:53 They take such a big trauma that it overwhelms the body.

05:57 But you try and try and try, you have that patient in critical care, but they just can't recover from that injury, and, eventually, they end up in multi-system failure.

06:06 It's really a difficult experience both for healthcare deliverers and for the patient's families, because they have that hope, and then, gradually, you see the systems one by one shut down.

06:18 So, initially, if it's going to be a relatively short time that they survive, we're looking at brain herniation, hypoxic-ischemic damage.

06:26 We've got hemorrhage or shock.

06:27 But if it's a longer time that they survive, they're really at risk for multi-system failure.