It’s your first shift of four-in-a-row and little do you know that you are in for a tough stretch! Your shift starts out calmly enough, but at 0200 you take report on a 23-yr old post-surgical trauma patient who came in through the ED due to a pedestrian vs auto incident. The patient was crossing the road on a dark, rainy night when she was struck by a vehicle at approximately 30 mph. Her injuries are:
Taking care of patients with neurological injury means managing their intracranial pressure, or as it’s commonly called, ICP. And when we say neurological injury, keep in mind that we’re not just talking about people getting bonked on the head with a 2 x 4. We’re talking about space-occupying lesions, hydrocephalus, intracranial hemorrhage, subdural/epidural hematoma, even severe hyponatremia…basically anything that’s a key player in (drum roll please….) the Monro-Kellie doctrine.
A few years ago a local radio station had a contest…Hold Your Wee for a Wii. The contest rules dictated that the contestants would drink copious amounts of water and whoever could hold their pee the longest, won a Wii game console. Despite numerous physicians and nurses calling in to the switchboard to tell them how dangerous this was, their pleas were ignored. They undoubtedly thought…”It’s water…what’s the big deal?” Well, the big deal was that the winning contestant went to bed that afternoon and never woke up. It was an enormous tragedy and absolutely beyond heartbreaking. I can’t imagine what her loved ones went through to have someone close to them die from such an avoidable event. Hyponatremia is deadly serious…and here’s what we’re going to do about it.
When I first started in the ICU I was overwhelmed with all the different neuro diagnoses and how the treatments varied based on where the injury is located, what caused it, whether or not they’d had surgery yet…super confusing!
Looks like we’re having Neuro Week over here at Straight A Nursing Student…guess I’ve had the brain on the brain lately. Haha. I found a super-handy website of radiology tutorials that show how different neurological insults show up when scanned. While nurses are, of course, not radiologists, it is always good to have a basic idea of how these things look…if nothing else, you should be able to tell a “normal” scan from one that is super scary. For more detail than that, I read the radiologist’s report 🙂
Triple H Therapy is utilized to prevent vasospasm in patients with subarachnoid hemorrhage. These patients can be tricky as they will often look great right after their aneurysm has been treated (coiled or clipped), but they are not out of the woods yet. Vasospasm can occur up to two weeks after the initial insult (I’ve even heard of it occurring up to three weeks out…scary!). Most of the time, your greatest risk is within 4-12 days, and this is where the typical ICU nurse’s hyper-vigilence comes in…frequent neuro checks and maintenance of prescribed therapy are key components to helping prevent this devastating complication.