6- Neurological trauma chapter 68

S1-S5

4 foot, leg, ankle control

Concussion

A _______After head injury is a temporary loss of neurologic function with no apparent structural damage

Immediate craniotomy

A patient arrives at the ED via ambulance following a motor cycle accident. The paramedics state the patient was found unconscious at the scene of the accident, but briefly regained consciousness during transport to the hospital. Upon initial assessment, the patient's GCS score is 7. The nurse anticipates which of the following?

Epidural hematoma

A patient brought to the hospital after a skiing accident was unconscious for a brief period of time at the scene, and woke up this orientated and refused to go to the hospital for treatment. The patient became very agitated and restless, then quickly lost consciousness again. What type of TBI is suspected in the situation?

Irrigates the wound to remove debris

A patient comes to the emergency department with a large scalp laceration after being struck in the head with a glass bottle. After assessment of the patient what does the nurse do before the physicians sutures the world?

Slurred speech, e) Vomiting, c) Weakness on one side of the body

A patient has been diagnosed with a concussion. The patient is preparing to be discharged from the ED. The nurse teaches the family members who will be caring for the patient to contact the physician or return to the ED if the patient demonstrates or complains of which of the following?

Hydralazine hydrochloride (apressalone) IV administered slowly

A patient has developed Autonomic dysreflexia and all measures to identify a trigger have been unsuccessful. What medication cannot nurse provided as ordered by the physician to decrease the blood pressure?

Rationale

Acute complications of SCI include spinal and neurogenic shock and deep-vein thrombosis (DVT). The spinal shock associated with SCI reflects a sudden depression of reflex activity in the spinal cord (areflexia) below the level of injury. Cardiogenic shock is not associated with SCI. Tetraplegia is paralysis of all extremities after a high cervical spine injury. Paraplegia occurs with injuries at the thoracic level. Autonomic dysreflexia is a long-term complication of spinal cord injury.

Rationale

An area of ecchymosis (bruising) may be seen over the mastoid (Battle's sign) in a basilar skull fracture. Basilar skull fractures are also suspected when CSF escapes from the ears (CSF otorrhea) and the nose (CSF rhinorrhea). A simple (linear) fracture is a break in bone continuity. A comminuted fracture refers to a splintered or multiple fracture line.

Rationale

An epidural hematoma can result from a skull fracture that causes a rupture or laceration of the middle meningeal artery. A subdural hematoma is a collection of blood between the dura and the brain. An intracerebral hemorrhage is bleeding into the substance of the brain. A DAl involves widespread damage to axons in the cerebral hemispheres, corpus callosum, and brain stem.

______

An object on the skin or skin pressure may precipitate an autonomic dysreflexic episode. A number of stimuli may trigger this reflex: distended bladder (the most common cause); distention or contraction of the visceral organs, especially the bowel (from constipation, impaction); or stimulation of the skin (tactile, pain, thermal stimuli, and pressure ulcer). The trigger is removed, and the patient is placed in a sitting position immediately to lower blood pressure.

Brain injury

Any brain damage that impairs normal functioning of the brain, either temporarily or permanently

Brain injury

Any damage to tissues of the brain that leads to impairment of the function of the Central Nervous System

Independent and transfers and wheelchair

Bill a 38-year-old man who is drinking heavily at a party got into his car and drove home against advice of friends. While driving he crossed the opposite lane, swerve to get back into his lane, and hit a street sign. He was ejected from the vehicle and a passing motorist who witnessed the event called 911. After stabilization at the scene and transport to the emergency department it was determined that Bill sustained a complete C6 fracture as well as a fractured left femur. He has been in the hospital for three weeks. Bill states to The nurse I will never be able to do anything for myself anymore. I will have to live in a nursing home where someone will take care of me. What level of independence canned the nurse expect that Bill will have after rehabilitation?

Systemic infections, neurosurgical infections, heterotrophic ossification

Complications after Trumatic head injuries can be classified according to

Rationale

Contusions are characterized by loss of consciousness associated with stupor and confusion. Other characteristics can include tissue alteration and neurologic deficit without hematoma formation, alteration in consciousness without localizing signs, and hemorrhage into the tissue that varies in size and is surrounded by edema. The effects of injury (hemorrhage and edema) peak after about 18 to 36 hours. A concussion is a temporary loss of neurologic function with no apparent structural damage. A diffuse axonal injury involves widespread damage to the axons in the cerebral hemispheres, corpus callosum, and brain stem. An intracranial hemorrhage is a collection of blood that develops within the cranial vault.

Brown-Sequard Syndrome

Damage to half of spinal cord Loss of pain and temperature sensation on contralateral side of body Loss of proprioception and discriminatory touch on ipsilateral side of body.

In brown-sequard syndrome, ipsilateral paralysis or paresis is noted, Together with ipsilateteral loss of touch, pressure, and vibration, and contralateral loss of sensation of pain and temperature.

Describe the characteristic clinical manifestations of brown-sequard syndrome

Rationale

Eating, breathing, transferring to a wheelchair, and writing are functional abilities for those with a T4 injury. Ambulation can be performed independently by a patient with a T11-55 injury.

Rationale

Fever in the patient with a TBI can be the result of damage to the hypothalamus, cerebral irritation from hemorrhage, or infection. The nurse monitors the patient's temperature every 2 to 4 hours. If the temperature increases, efforts are made to identify the cause and to control it using acetaminophen and cooling blankets to maintain normothermia. The remaining clinical findings are within normal limits.

Because hypoxia can create or worse than a neurologic deficit of the spinal cord

For a patient with An SCI, why is it beneficial to administer oxygen to maintain a high partial pressure of oxygen?

______

Fractures of the base of the skull tend to traverse the paranasal sinus of the frontal bone or the middle ear located in the temporal bone. Therefore, they frequently produce hemorrhage from the nose, pharynx, or ears, and blood may appear under the conjunctiva. An area of ecchymosis (bruising) may be seen over the mastoid (Battle's sign). Basilar skull fractures are suspected when CSF escapes from the ears (CSF otorrhea) and the nose (CSF rhinorrhea). Drainage of CSF is a serious problem, because meningeal infection can occur if organisms gain access to the cranial contents via the nose, ear, or sinus through a tear in the dura. A blood stain surrounded by a yellowish stain on the head dressing is referred to as a halo sign and is highly suggestive of a CSF leak.

C7-C8

Full elbow extension, wrist plantar flexion

T-1-T-5

Full hand and finger control

T11-L5

Knee flexion and ankle dorsiflexion

The most common cause of TBI our falls 35.2% motor vehicle crashes 17.3% being struck by objects 16.5% and assaults 10%

Name the four most common causes of Traumatic brain injury TBI

Concussion treatment

Patients are discharged from the hospital or ED once they return to baseline after a concussion. Monitoring includes observing the patient for a decrease in level of consciousness (LOC), worsening headache, dizziness, seizures, abnormal pupil response, vomiting, irritability, slurred speech, numbness, or weakness in the arms or legs. In general, the finding of headache in the patient with a concussion is an expected abnormal observation. However, a severe headache should be reported or treated immediately. Weakness of one side of the body should be reported or treated immediately. Difficulty in waking the patient should be reported or treated immediately.

Rationale

Posttraumatic seizures are classified as immediate (within 24 hours after injury), early (within 1 to 7 days after injury), or late (more than 7 days after injury). Seizure prophylaxis is the practice of administering antiseizure medications to patients with head injury to prevent seizures. It is important to prevent posttraumatic seizures, especially in the immediate and early phases of recovery, because seizures may increase intracranial pressure and decrease oxygenation

An area of bruising over the mastoid bone

The ED nurse is receiving a patient-handoff report at the beginning of the nursing shift. The departing nurse notes a patient with a head injury has Battle's sign. The nurse will expect which of the following clinical manifestation?

Rationale

The GCS assesses the patient's LOC by testing and scoring three observations: eye opening, motor response, and verbal stimuli response. Patients are scored on their best responses and these scores are totaled. The highest score is 15. The highest responses in these three categories are spontaneous eye opening, obeying motor commands, and orientation to time, place, and person. Changes in vital signs and unequal pupil size occur with increased ICP, but are not part of the GCS. Incomprehensible verbal response is a score of 2 on the GCS, and therefore could not contribute to a score of 15. Change from a patent's baseline GCS score always requires investigation.

Brain, blood, cerebral spinal fluid

The cranial vault contains three main components

CT scan

This is used to diagnose a skull fracture

A brain injury to a patient results in facial paralysis. Which descending tract is most likely affected?

corticobulbar tract

Traumatic head injury, conscious in ER followed by unconsciousness

epidural hematoma

Coma

he nurse has documented a patient diagnosed with a head injury as having a Glasgow Coma Scale (GCS) score of 7. This score is generally interpreted as which of the following?

Concussion symptoms

most result in a short-term headache and the tissue heals itself, but more serious ones may cause loss of consciousness, confusion, and drowsiness with some permanent tissue damage

Ipsilateral

on the same side of the body as another structure

subdural hematoma

pertaining to below the dura mater, tumor of blood

TBI

s/s: LOC, nasal discharge, stiff neck, restlessness, n/v, posturing (decerebrate/decorticate) CSF leakage, hyperthermia, *Cushings triad* hypertension, bradycardia, widening pulse pressure Rx: Mannitol, steroids (Decadron) IV push, barbiturate coma induced to treat refractory IICP, neuromuscular blocking agent (Norcuron) to decrease agitation, ICP monitor Nursing: *HOB 30˚, midline*, avoid flexion/extension of head, O2, avoid morphine, maintain body temp to prevent shivering (increases ICP), decrease stim, limit fluid intake to 1200ml day, avoid straining, seizure precautions, monitor for herniation: irreg breathing, irreg pulse, loss of brainstem reflexes (blinking, gagging, pupil reaction) resp/cardiac arrest

Basilar

A patient in the ER has bruising over the mastoid bone and rhinorrhea. The triage nurse suspects the patient has which type of skull fracture?

Place the patient in a sitting position

A patient with a C7 spinal cord fracture in forms the nurse my head is killing me. The nurse assesses a blood pressure of 210/140, heart rate of 48 and I hope serves diaphoresis on the face. What is the first action by the nurse?

T6-T10

Abdominal muscle control, partial good balance

C 5

Full head and neck control

C6

Fully innervated shoulder

Rationale

Hypertension and diaphoresis are signs of autonomic dysreflexia. Nasal congestion often accompanies autonomic dysreflexia. Bradycardia, not tachycardia, occurs with autonomic dysreflexia. Although the patient may be diaphoretic, a fever does not accompany this condition,

C 2- C3

Independent of mechanical ventilation for short periods

C 1

Requires continuous ventilation

Brown-Sequard Syndrome (Lateral Damage)

Results when only one side of the cord is damaged, as in a stabbing or gunshot injury. Motor paralysis and deficits in kinesthesia and proprioception occur below the level of injury, on the ipsilateral side. Loss of pain, temperature, and touch sensation occurs on the contralateral side.

______

Signs of increasing ICP include slowing of the heart rate (bradycardia), increasing systolic blood pressure, and widening pulse pressure (Cushing's reflex). As brain compression increases, respirations become rapid, the blood pressure may decrease, and the pulse slows further. This is an ominous development, as is a rapid fluctuation of vital signs. The temperature is maintained at less than 38 C (100.4 F). Tachycardia and arterial hypotension may indicate that bleeding is occurring elsewhere in the body.

Linear, comminuted, depressed, frontal, temporal, and basilar

Skull fractures are classified by type and location. Types include_______ ________ and ________ skull fractures, while location fractures include_______ ______ _______ skull fractures.

Rationale

The areas around the four pin sites of a halo device are cleaned daily and observed for redness, drainage, and pain. The pins are observed for loosening, which may contribute to infection. If one of the pins becomes detached, the head is stabilized in a neutral position by one person while another notifies the neurosurgeon. The skin under the halo vest is inspected for excessive perspiration, redness, and skin blistering, especially on the bony prominences. The vest is opened at the sides to allow the torso to be washed. The liner of the vest should not become wet because dampness causes skin excoriation. The liner should be changed periodically to promote hygiene and good skin care. Powder is not used inside the vest because it may contribute to the development of pressure ulcers.

Fifth cervical, sixth cervical, seventh cervical, 12 thoracic, first lumber

The five vertebrae most commonly involved in spinal cord injuries are the

Coma, hypertension, bradycardia, Bradypnea

The four signs of a rapidly expanding, acute subdural hematoma that would require immediate surgical intervention are

Hematoma either epidural subdural or intracerebral

The most serious brain injury that can develop within the cranial vault is a

Basilar skull fracture

The nurse in the emergency department is caring for a patient brought in by the rescue squad after falling from the second story window. The nurse assesses Eccymosis over the mastoid air clear fluid from the ears. What type a school fracture is this indicator of?

a) 3, 4, 5

The nurse is assessing the LOC of patient who has suffered a head injury. The client's GCS score is 15. Which of the following did the nurse observe to arrive at a score of 15? Select all that apply. 1. Bradycardia and hypotension 2. Incomprehensible sounds 3. Obeying motor commands 4. Oriented to person, place, and time 5. Spontaneous eye opening 6. Unequal pupil size

Hypertension, b) Diaphoresis, a) Nasal congestion

The nurse is assigned to care for patients with SCI on a rehabilitation unit. Which of the following does the nurse recognize are clinical manifestations of autonomic dysreflexia? Select all that apply.

Applying a blanket over the patient

The nurse is caring for a patient with a spinal cord lesion above T6. Which of the following stimuli is known to trigger an episode of autonomic dysreflexia?

Motor vehicle crashes

The nurse is conducting a health fair on spinal cord injury (SCI) at a local high school. The nurse relays that which of the following is the most common cause of SCI?

A major aspect of nursing care is educating the patient and family about complications and strategies to minimize rest. UTIs, contractures, infected pressure ulcers, and sepsis may necessitate hospitalize Asian. Other leg complications that may occur include lower extremity edema, joint contractures, respiratory dysfunction, and pain. To avoid these And other complications, the patient and a family member are educated about skincare, catheter care, range of motion exercises, breathing exercises, and other care techniques.

When is the nurse educates Bill about prevention of complications after going home what does the nurse include?

Eating, c) Breathing, d) Transferring to a wheelchair, b) Writing

Which of the following activities would the patient with a T4 spinal cord injury be able to perform independently?

Young age, d) Alcohol use, a) Drug abuse

Which of the following are risk factors for SCI? Select all

Subdural hematoma

Which of the following conditions occurs when bleeding occurs between the dura mater and arachnoid membrane?

Widened pulse pressure

Which of the following findings in the patient who has sustained a head injury indicate increasing intracranial pressure (ICP)?

Contusion

Which type of brain injury is characterized by a loss of consciousness associated with stupor and confusion?

Epidural

Which type of hematoma results from a skull fracture that causes a rupture or laceration of the middle meningeal artery?

Grade 3 concussion

While riding a bicycle in a race, a patient fell into a ditch and sustained a head injury. Another cyclist found the patient lying unconscious in the ditch and called 911. What type of concussion does the patient most likely have?

18-36hrs

While stopped at a stop sign of patients car was struck from behind by another vehicle. The patient sustained a cerebral contusion and was admitted to the hospital. During what time period After the injury will the effects of injury Peak?

brain death

a diagnosis of death based on the cessation of all signs of brain activity, as measured by electrical brain waves

Glasgow Coma Scale (GCS)

a scale used to assess the consciousness of a patient upon physical examination, typically in patients with neurological concerns or complaints

Brain injury

an injury to the skull or brain that is severe enough to interfere with normal functioning

A grade one concussion has symptoms of transient confusion, no loss of consciousness, and duration of mental status abnormalities on examination that resolve in less than 15 minutes

A patient sustained a grade one head injury. Describe the clinical manifestations that would be seen with this type of injury

Prpofol (diprivan)

A patient sustained a head injury and has been admitted to the neural surgical intensive care unit. The patient began having seizures and was administered a suv date of hypnotic medication that is ultra short acting and can be titrated to patient response. What medication will the nurse be monitoring during this time?

An intracerebral hematoma

A patient sustained a head trauma in a diving accident and has a cerebral hemorrhage located with in the brain. What type of hemotoma is this classified as?

It allows for stabilization of the cervical spine along with early ambulation

A patient was body surfing in the ocean and sustained a cervical spinal cord fracture. I halo traction device was applied. How does the patient benefit from the application of the halo device?

Rationale

A strategy the nurse can implement to prevent patient injury is to use an external sheath catheter for a male patient if incontinence occurs. Because prolonged use of an indwelling catheter inevitably produces infection, the patient may be placed on an intermittent catheterization schedule. Opioids are contraindicated because they depress respirations, constrict the pupils, and alter responsiveness. Providing adequate lighting to prevent visual hallucinations is recommended. Repositioning the patient every 2 hours maintains skin integrity

subdural hematoma

A_______ is bleeding between the dura mater and arachnoid membrane. Intracerebral hemorrhage is bleeding in the brain or the cerebral tissue with displacement of surrounding structures. An epidural hematoma is bleeding between the inner skull and the dura, compressing the brain underneath. An extradural hematoma is another name for an epidural hematoma

Menro-kellie doctrine

According to the_______The cranial vault is a closed system and if one of the three components increases in volume, at least one of the other two must decrease in volume, or the pressure will increase.

C-4

Good head and neck sensation and motor control

Burr holes

The nurse is caring for a patient in the emergency department with a diagnosed epidural hematoma What procedure well the nurse prepare the patient for?

Monitoring includes observing the patient for a decrease in LOC worsening headache, dizziness, seizures, abnormal pupil response, Vomiting, irritability, slurred speech, and numbness or weakness in the arms or legs.

When a patient sustained a head injury and is admitted to the hospital for observation what will be monitored?

Rationale

Patients with brain injury are assumed to be catabolic and nutritional support consultation should be considered as soon as the patient is admitted. Parenteral nutrition via a central line or enteral feedings administered via an NG or nasojejunal (NJ) feeding tube should be considered. If CSF rhinorrhea occurs, an oral feeding tube should be inserted instead of a nasal tube. Serial studies of blood and urine electrolytes and osmolality are done because head injuries may be accompanied by disorders of sodium regulation. Urine is tested regularly for acetone. An intervention to maintain skin integrity is getting the patient out of bed to a chair three times daily.

GCS

The GCS is a tool for assessing a patient's response to stimuli. A score of 7 or less is generally interpreted as a coma. The lowest score is 3 (least responsive/deep coma); the highest is 15 (most responsive). A GCS between 3 and 8 is generally accepted as indicating a severe head injury. No category is termed "least" responsive.

Spinal shock

The nurse is caring for a patient immediately following a spinal cord injury (SCI). Which of the following is an acute complication of spinal cord injury?

Young age, male gender, substance abuse

The nurse is planning to provide education about prevention in the community YMCA due to the increase in numbers of spinal cord injuries. What predominate risk factors does the nurse I understand will have to be addressed?

The patient will be able to ambulate independently

The patient has an S5 spinal fracture from a fall. What type of assistive device will this patient required?

Rationale

The predominant risk factors for SCI include young age, male gender, and alcohol and drug use. The frequency with which these risk factors are associated with SCI serves to emphasize the importance of primary prevention

Coma, absence of brainstem reflexes, apnea

The three cardinal signs of brain death are

a) Ineffective airway clearance: suction patient as indicated., d) Disturbed sleep pattern: provide the patient with back rubs., e) Interrupted family process: encourage family to join a support group.

The following statements match nursing interventions with nursing diagnoses. Which statements are true for a patient who has suffered a head injury? Select all that apply.

Rationale

The most common causes of SCIs are motor vehicle crashes ( 46 % ) , falls ( 22 % ) violence ( 16 % ) , and sports ( 12 % ) . Males account for 80 % of patients with SCI . An estimated 50 % to 70 % of SCIs occur in those aged 15 to 35 years .

Applying an external urinary sheath catheter

The nurse is caring for a male patient who has emerged from a coma following a head injury. The patient is agitated. Which of the following interventions will the nurse implement to prevent patient injury?

1 to 7 days of injury

The nurse is caring for a patient following a head injury. The nurse understands that the patient is at risk for posttraumatic seizures. A seizure that is classified as early occurs within which timeframe?

"ll check under the liner for blisters and redness."

The nurse is caring for a patient following an SCI who has a halo device in place. The patient is preparing for discharge. Which of the following statements made by the patient indicates the need for further instruction?

Maintaining cerebral perfusion pressure from 50 to 70 mm Hg

The nurse is caring for a patient in the neurologic ICU who sustained a severe brain injury. Which of the following nursing measures will the nurse implement to aid in controlling ICP?

Absence of brain stem reflexes, a) Apnea, c) Coma

The nurse is caring for a patient who is being assessed for brain death. Which of the following cardinal signs of brain death?

Eye-opening, verbal responses, motor responses to verbal commands or painful stimuli

The three criteria used to assess the level of consciousness using the glasgow coma scale are

Rationale

These nursing diagnoses match the interventions correctly. The goal of hydration is to prevent dehydration or fluid overload; fluid replacement is based on the patient's individual needs. CPP should be maintained between 50 and 70 mm Hg.

Brain Injury Visual Assessment Battery for Adults (biVABA)

This battery identifies functional limitations resulting from visual impairment. The series of eye and visual tests includes papillary response, oculomotor performance, eye dominance, visual attention, visual search, acuity, reading acuity, contrast sensitivity, and visual fields.

TBI (traumatic brain injury)

This occurs when an external force injures the brain. Symptoms can be mild (concussion) to severe (depressed skull fractures). Treatments include bed rest, craniotomy, and monitoring of vital signs and behavior.

The diet for the patient with tetraplegia or paraplegia should be high in protein, vitamins, and calories to ensure minimal wasting of muscle and the maintenance of healthy skin, and high and fluids to maintain well functioning kidneys. Excessive weight gain and obesity should be avoided, because they further limit mobility.

What dietary information should bill be educated about in order to maintain a healthy lifestyle and prevent complications?

20/15 x 60 80 mL/hr

The nurse is caring for a patient diagnosed with an acute subdural hematoma following a craniotomy. The nurse is preparing to administer an IV dose of dexamethasone (Decadron). The medication is available in a 20-mL IV bag and ordered to be infused over 15 minutes. At what rate (mL/hr) will the nurse set the infusion pump?

Temperature increase from 98.0°F to 99.6 F

The nurse is caring for a patient with TBI (traumatic brain injury). The nurse notes the following clinical findings during the reassessment of the patient. Which of the following will cause the nurse the most concern?

Insertion of a nasogastric (NG) tube

The nurse is caring for a patient with a head injury. The patient is experiencing CSF rhinorrhea Which of the following orders should the nurse question?

Making nursing assessments, setting priorities for nursing interventions, anticipating needs and complications, initiating rehabilitation

The nurse is planning the care of a patient with a TBI in the neurosurgical ICU. In developing the plan of care, what interventions should be a priority?

Rationale

The nurse should maintain cerebral perfusion pressure from 50 to 70 mm Hg to aid in controlling increased ICP. Other measures include elevating the head of the bed as prescribed, maintaining the patient's head and neck in neutral alignment (no twisting or flexing the neck), initiating measures to prevent the Valsalva maneuver (e.g., stool softeners), maintaining body temperature within normal limits, administering O2 to maintain Pa02 greater than 90 mm Hg, maintaining fluid balance with normal saline solution, avoiding noxious stimuli (e.g., excessive suctioning, painful procedures), and administering sedation to reduce agitation. Maintain cerebral perfusion pressure from 50 to 70 mm Hg. Alternative measures to restraints should be implemented, and stool softeners verses enemas should be used to avoid increasing ICP

Rationale

The patient is experiencing an epidural hematoma. An epidural hematoma is considered an extreme emergency; marked neurologic deficit or even respiratory arrest can occur within minutes. Treatment consists of making openings through the skull (burr holes) to decrease ICP emergently, remove the clot, and control the bleeding. A craniotomy may be required to remove the clot and control the bleeding. Epidural hematomas are often characterized by a brief loss of consciousness followed by a lucid interval in which the patient is awake and conversant. During this lucid interval, compensation for the expanding hematoma takes place by rapid absorption of CSF and decreased intravascular volume, both of which help to maintain the ICP within normal limits. When these mechanisms can no longer compensate, even a small increase in the volume of the blood clot produces a marked elevation in ICP. The patient then becomes increasingly restless, agitated, and confused as the condition progresses to coma.

Rationale

The three cardinal signs of brain death on clinical examination are coma, the absence of brain stem reflexes, and apnea. Adjunctive tests, such as cerebral blood flow studies, electroencephalogram (EEG), transcranial Doppler, and brain stem auditory evoked potential, are often used to confirm brain death.

Primary injury is the initial damage to the brain that results from the Trumatic event. This may include contusions, lacerations, And torn blood vessels due to impact, acceleration or deceleration or foreign object penetration. Secondary injury evolves over the ensuing hours and days after the initial injury and results from an inadequate delivery of nutrients and oxygen to the cells. These processes include intracranial hemorrhage, cerebral Adema, increased intracranial pressure, hypoxic brain damage, and infection.

What is the difference between primary and secondary brain injury