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■ Rapid drainage is a neurosurgical emergency.
■ Stoppage of drainage may indicate a clot.
■ Check dressing for drainage or signs of infection.
■ Check tubing patency.
■ Keep patient on bedrest with HOB 30º–45º.

Traumatic Brain Injury (TBI)
TBI refers to trauma to the scalp and skull that may or may not include injury to
the brain. There are several types of acute head injuries:
■ Closed head injury: The skull is not broken.
■ Penetrating head injury: Object pierces the skull and breaches the dura
mater.
■ May also be diffuse or focal.
Pathophysiology
Trauma → intracranial hemorrhage and hematoma → brain swelling →↑ intracra-
nial volume and ↑ ICP → displacement or herniation of the brain. Pressure on cere-
bral blood vessels →↓ blood flow to brain →↓ O 2 to brain → cerebral hypoxia
→ cerebral ischemia, infarction, and irreversible brain damage → brain death.
Clinical Presentation
■ Persistent, localized pain; headache
■ Loss of consciousness, confusion, drowsiness, lethargy, personality change,
irritability, restlessness, agitation, anterograde or retrograde amnesia
■ Sudden onset of neurological deficits including hemiparesis, “dolls’ eyes”
■ Decorticate or decerebrate posturing
■ Bruising over mastoid (Battle’s sign)
■ Nausea and vomiting, dizziness
■ CSF otorrhea (ears) or rhinorrhea (nose)
■ Halo sign: blood stain surrounded by a yellowish stain on bed linens or
head dressing that may indicate CSF leak
■ Abnormal pupillary response; pupils may be unequal; diplopia possible
■ Altered or absent gag or cough reflex
■ Absent corneal reflex
■ Change in vital signs: altered respiratory pattern, widened pulse pressure,
bradycardia, or tachycardia; labored breathing that may be shallow and
irregular with periods of apnea
■ Seizures
NEURO