Traumatic Brain Injury
Pathophysiology
Traumatic brain injury, continues to remain an enigma and treatment is elusive, causing death and disability across the globe. Luckily, significant progress has been made in helping improve short-term outcome in victims facing a severe brain injury. Unfortunately, it is still not possible to get back the victims to their normative level of brain functioning. Injuries to the brains caused by forceful impact may cause tissue distortion. Clinically, outcome depends on the mediating the cellular changes and bimolecular changes caused due to the injury. Secondary brain injuries lead to alteration in the functioning of the cell through disruption of homeostasis, excitotoxicity, free radical generation, and depolarization. It may also propagate injury through intracranial hypertension, edema formation, blood- brain barrier disruption and ischemic injury. To help improve the outcome in patients suffering from traumatic injuries, it is necessary to understand evolution of therapies and processes that are known to help limit secondary brain injury (Greve & Zink, 2009).
2. Standard of Practice
The newly developed Canadian guidelines can help aid healthcare professionals to implement best practices, meant to help challenged population (experiencing post concussive symptoms (PPCS) which follows a mild traumatic brain injury (MTBI) also referred to as concussion or mild head injury. This head disorder has become common today and there is increased public awareness through reportage of concussion in sport prevention and media attention on injuries associated with military blast (Marshall, Bayley, McCullagh, Velikonja, & Berrigan, 2012)
Studies on MTBI hospital treated cases and those presented to family physicians have been estimated to be between 653 and 493 per 1000 people in Ontario. It is now expected that cases of patients experiencing MTBI will recover within months or even days. According to the Centers of disease control and prevention (CDC), 15% of the patients diagnosed with MTBI experience persistent disabling problems. Such cases are few, especially if we look at the high incidences of MTBI. (Marshall, Bayley, McCullagh, Velikonja, & Berrigan, 2012).
a. Evidence-based pharmacological treatment and how they affect management of the disease in the community.
In spite of the massive investment by the government and commercial entities in the past decades, TBI (Traumatic brain injury) remains the main source of mortality and disability in both developing and developed countries. There are over 500 researches funded by The U.S. Department of Defense Neurotrauma Research portfolio. The research aims at developing interventions that will mitigate the effect of trauma and improve quality of life outcome. The portfolio looks at the need for the best pharmacological approaches that can be used to treat TBI and its symptoms. USAMRMC (The U.S. Army medical Research and Material Command) established the Neutrauma Pharmacology Workgroup whose goal is to develop pharmacological treatments aimed at improving TBI clinical outcomes (Arrastia, et al., 2014).
Pre-clinical studies have focused on testing the drug's efficacy in animals. It targets secondary injury including growth factors, calcium channel blockers, free radical scavengers, N- methyl D-aspartate (NMDA) magnesium sulfate and corticosteroids. Phase II clinical trials evaluate efficacy of combinations, such as PEG-SOD (polyethylene glycol conjugated superoxide dismutase) nimodopine, triamcinolone and moderate hypothermia, (Xiong, Mahmood, & Chopp, 2010).
It should be noted that all approaches and compounds which have been tested in phase III trials have not shown any efficacy. The efficacy of using neuroprotective to treat TBI is uncertain. In some cases, manitol has effectively reduced brain swelling after TBI but it is not known whether it can actually manage severe TBI. Also, it has been proved that excessive administration of mannitol is harmful. Mannitol passes from bloodstream to the brain hence increasing the pressure which worsens swelling. Data on the effectiveness of pre-hospital administration is so far insufficient. (Xiong, Mahmood, & Chopp, 2010).
b. Clinical guidelines that can be used to assess, diagnose patient education.
According to the Emergency Department, diagnosis of the mild TBI is critical in successful management of patients, most of whom may be unaware that they have sustained TBI. When there is evidence of direct trauma, injury to the head especially after an accident mTBI should be suspected. Some patients may present post traumatic amnestic state where they may show GCS score of 15/15 and may not be able to form an intelligible memory pattern.
In such a case, the patient should be monitored in order to rule out life threatening complication including intracranial hemorrhage and prepare the patient for possible delayed complications. This is done in order to monitor and rule out any life threatening complications (ONF, n.d.).
Acute...
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