Cerebral injuries and intracranial hemorrhages as a result of trauma.

Cerebral injuries refer to an actual injury to the brain matter. Injuries seen are concussion, contusion, or diffuse axonal injury. Bleeding into any of the meningeal spaces, brain, or ventricles is known as intracranial hemorrhage. Seldom do cerebral injuries appear as distinct entities but rather as a combination of injuries. The neurologic dysfunction is the sum total of the injury. The significance of the initial injury lies in the development of secondary events, such as edema, hemorrhage, and swelling. These events may lead to further deterioration and neurologic dysfunction. Treatment is directed at preservation of brain homeostasis and prevention of secondary injury. Controlled hyperventilation is the mainstay in the treatment of increased ICP. Other therapies include barbiturate coma and the use of corticosteroids to reduce ICP. Nursing interventions focus on methods to promote cerebral perfusion and support other body systems affected by immobility and altered level of consciousness. Planning nursing care and activities to the patient's ICP and CPP responses is indicated.