중환자실습 사례보고서 - 뇌출혈(외상성 경막하 출혈)

문서 내 토픽

1. Traumatic subdural hemorrhage (외상성 경막하 출혈)

외부 충격으로 인해 뇌를 둘러싸고 있는 경막 혈관이 파열되어 경막과 지주막하 공간에 출혈이 일어난 것으로, 대부분 시상정맥동이 파열되어 나타난다. 정맥혈이기 때문에 혈종은 느리게 형성되나 혈종이 뇌표면에 압력을 가하게 되고, 혈종이 커지면 결국 뇌조직을 이동시키므로 조치가 늦어지면 사망에 이를 수 있다. 임상적 징후가 나타나는 시기에 따라 급성, 아급성, 만성으로 분류한다.
2. 치료

외상으로 인한 경막하 출혈시 목뼈(경추) 손상이 동반될 수 있기 때문에 방사선 검사로 확인 될 때까지 목뼈를 보호하며 치료한다. 비수술요법으로는 약물요법, 혼수요법, 체액과 전해질 관리가 있으며, 수술요법으로는 두개내압 지속적 모니터링, 개두술 등이 있다.
3. 합병증 및 예후

두부 외상 후 발작이 발생하여 평생동안 항경련제를 필요로 하거나 수두증 치료가 필요할 수도 있다. 또한, 외상에 대한 자동적인 반응으로 위산 생성이 증가하여 소화성 궤양이 발생한다. 치료기간 동안 합병증은 무기폐, 폐렴, 심혈관의 손상, 피부파괴, 근육위축, 변비 등이 있다. 외상성 경막하 출혈의 사망률은 뇌출혈 및 뇌 손상의 정도에 따라 결정되며, 수술 전 의식 수준이 나쁜 환자들은 사망률이 매우 높다.
4. 간호중재

중증도에 따라 응급실에서 치료 후 퇴원하거나 중환자실에 입원한다. 간호중재로는 가스교환과 기도개방 유지, 정상체온 유지, 감각과 인지기능 증진, 적절한 영양상태 유지, 환자와 가족 교육 등이 있다.
5. 진단적 검사

X-ray, Brain CT, Skull series 등의 검사를 통해 폐 질환, 두개골 골절, 뇌출혈 등을 확인한다. 일반혈액검사 및 일반혈청검사, ABGA 등을 통해 감염, 면역기능, 신장기능, 전해질 균형 등을 확인한다.
6. 약물치료

Keppra, Tylenol, Gliatilin, Stogar, Myonal, Lacidofil, Penid, Skad B, Ascorbic acid, Beecom Hexa, Tabactam, Acetphen premix, Muteran, Mannitol 15%, Perdipine, Lasix 등의 약물이 투여되고 있다.
7. 기타 치료

치료식 경관 표준 RTH 1,200kcal 1,200ml, Bed rest, Position change q 2hrs, Tracheostomy, ABGA 시행, Physical restraint 적용 등의 치료가 이루어지고 있다.

Easy AI와 토픽 톺아보기

1. Traumatic subdural hemorrhage (외상성 경막하 출혈)

Traumatic subdural hemorrhage is a serious medical condition that occurs when blood accumulates between the dura mater and the arachnoid mater, the two outermost layers of the meninges that cover the brain. This type of hemorrhage is often caused by head trauma, such as a fall or a car accident, and can lead to increased intracranial pressure, brain damage, and even death if not treated promptly and effectively. The severity of the injury can vary greatly depending on the extent of the bleeding, the location of the hemorrhage, and the underlying brain damage. Prompt diagnosis and appropriate treatment are crucial for improving the patient's prognosis and minimizing the risk of long-term neurological complications.
2. 치료

The primary goal of treatment for traumatic subdural hemorrhage is to reduce intracranial pressure and prevent further brain damage. The specific treatment approach will depend on the severity of the injury and the patient's clinical presentation. In mild cases, conservative management with close monitoring, medication to control intracranial pressure, and supportive care may be sufficient. In more severe cases, surgical intervention may be necessary, such as burr hole drainage, craniotomy to evacuate the hematoma, or decompressive craniectomy to relieve pressure on the brain. The timing and type of surgical intervention will depend on the patient's clinical status, the size and location of the hemorrhage, and the presence of any underlying brain injuries. Rehabilitation and long-term follow-up are also crucial for patients who have experienced a traumatic subdural hemorrhage, as they may face ongoing cognitive, physical, and emotional challenges.
3. 합병증 및 예후

Traumatic subdural hemorrhage can lead to a variety of complications, depending on the severity of the injury and the extent of the brain damage. Some common complications include increased intracranial pressure, brain herniation, seizures, cognitive impairment, motor deficits, and even death. The prognosis for patients with traumatic subdural hemorrhage can vary widely, ranging from a full recovery to severe, long-term neurological deficits or even death. Factors that can influence the prognosis include the patient's age, the severity of the initial injury, the presence of any underlying medical conditions, the timeliness and effectiveness of treatment, and the patient's response to rehabilitation. In general, patients with smaller, more localized hemorrhages and those who receive prompt and appropriate treatment have a better prognosis than those with larger, more diffuse hemorrhages or those who experience significant delays in receiving care. Ongoing monitoring and rehabilitation are essential for optimizing the patient's long-term outcomes.
4. 간호중재

Nursing interventions play a crucial role in the management of patients with traumatic subdural hemorrhage. Nurses are responsible for closely monitoring the patient's neurological status, vital signs, and intracranial pressure, and promptly reporting any changes to the healthcare team. They also play a key role in administering medications, managing the patient's airway and respiratory function, and providing supportive care to prevent complications such as pressure ulcers, deep vein thrombosis, and respiratory infections. Nurses also play a vital role in coordinating the patient's care, communicating with the healthcare team, and providing education and support to the patient and their family members. Additionally, nurses may be involved in the patient's rehabilitation process, helping to facilitate physical, occupational, and cognitive therapy as the patient recovers. Overall, the nurse's role in the management of traumatic subdural hemorrhage is essential for optimizing the patient's outcomes and supporting their recovery.
5. 진단적 검사

Accurate and timely diagnosis is crucial for the management of traumatic subdural hemorrhage. The primary diagnostic tool is neuroimaging, typically starting with a computed tomography (CT) scan of the head, which can quickly identify the presence and location of the hemorrhage. In some cases, magnetic resonance imaging (MRI) may be used to provide more detailed information about the extent and characteristics of the hemorrhage. Other diagnostic tests may include laboratory tests to assess the patient's coagulation status, electrolyte levels, and other markers of injury or infection. Neurological examinations, including assessments of the patient's level of consciousness, pupillary response, and motor function, are also essential for monitoring the progression of the injury and guiding treatment decisions. In some cases, invasive monitoring, such as intracranial pressure monitoring, may be necessary to closely track changes in intracranial pressure and guide the management of the condition. Prompt and accurate diagnosis is crucial for ensuring that the patient receives appropriate and timely treatment to minimize the risk of further brain damage and improve their overall prognosis.
6. 약물치료

Pharmacological interventions play a crucial role in the management of traumatic subdural hemorrhage. The primary goals of medication therapy are to reduce intracranial pressure, prevent further bleeding, and manage any associated complications. Common medications used in the treatment of traumatic subdural hemorrhage include: 1. Antihypertensive drugs: These medications, such as labetalol or nicardipine, are used to control elevated blood pressure and reduce the risk of further bleeding. 2. Diuretics: Medications like mannitol or hypertonic saline are used to reduce intracranial pressure by drawing fluid out of the brain and reducing cerebral edema. 3. Anticonvulsants: Drugs like phenytoin or levetiracetam are often prescribed to prevent seizures, which can occur as a complication of the hemorrhage. 4. Corticosteroids: These medications, such as dexamethasone, may be used to reduce inflammation and edema in the brain, although their use remains controversial. 5. Antifibrinolytic agents: Medications like tranexamic acid may be used to help prevent further bleeding by inhibiting the breakdown of blood clots. The specific medication regimen will depend on the patient's clinical presentation, the severity of the hemorrhage, and any underlying medical conditions. Careful monitoring and adjustment of the medication plan are essential to ensure the patient's safety and optimize their recovery. Collaboration between the healthcare team, including physicians, pharmacists, and nurses, is crucial for the effective management of traumatic subdural hemorrhage using pharmacological interventions.
7. 기타 치료

In addition to pharmacological interventions, there are several other treatment modalities that may be employed in the management of traumatic subdural hemorrhage. These include: 1. Surgical interventions: As mentioned earlier, surgical procedures such as burr hole drainage, craniotomy, or decompressive craniectomy may be necessary in severe cases to evacuate the hematoma and relieve intracranial pressure. 2. Rehabilitation: Comprehensive rehabilitation, including physical, occupational, and cognitive therapy, is essential for patients recovering from traumatic subdural hemorrhage. These interventions can help improve the patient's functional abilities, cognitive skills, and overall quality of life. 3. Supportive care: Measures such as mechanical ventilation, fluid management, and nutritional support may be necessary to stabilize the patient and prevent further complications. 4. Neuromonitoring: Invasive monitoring techniques, such as intracranial pressure monitoring or cerebral perfusion monitoring, can provide valuable information to guide treatment decisions and optimize the patient's care. 5. Emerging therapies: Researchers are exploring novel treatment approaches, such as the use of neuroprotective agents, stem cell therapy, or hypothermia, to improve outcomes for patients with traumatic subdural hemorrhage. The specific combination of treatments will depend on the individual patient's needs and the expertise of the healthcare team. Effective communication and coordination among the various members of the care team are crucial for ensuring the best possible outcomes for patients with this complex and potentially life-threatening condition.

주제 연관 리포트도 확인해 보세요!