A+성인간호학실습_급성경막하출혈_SDH CASE STUDY_질병보고서 포함_진단5개 과정3개

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• 1. Acute SDH(Acute subdural hemorrhage)

  Acute SDH는 두부외상의 2차적 손상으로 skull fracture, cerebral concussion, cerebral contusion, cerebral laceration과 같은 1차 손상에 대한 신체의 반응에 기인하여 ICP상승 및 혈종을 형성한다. 대부분 머리에 대한 직접적인 충격으로 발생하며, 노인의 경우 낙상, 젊은 사람은 교통사고와 폭행, 무리한 운동에 의해 주로 발생한다. 급성 SDH는 가장 심각한 형태의 두부외상으로 의식장애가 동반되며, 출혈이 계속되고 cerebral edema가 생기면서 뇌압이 증가하면 환자의 의식이 급격하게 악화된다. 진단을 위해 CT를 통해 뇌와 두개골의 출혈량과 해부학적 위치를 확인하며, 치료는 내과적 중재와 외과적 중재로 구분된다.

• 2. Traumatic SAH(Traumatic subarachinoid hemorrhage)

  Traumatic SAH는 출혈성 뇌졸중 유형의 하나로, subarachnoid space(지주막하공간)에 생기는 출혈이다. 뇌동맥류 파열이나 뇌 손상으로 인한 뇌막 혈관의 파열로 발생한다. 뇌 조직, 신경 압박에 의한 증상과 혈관파열에 의한 증상이 나타나며, CT, MRI, 요추천자, 뇌혈관 조영술로 진단한다. 치료는 Acute SDH 간호와 유사하다.

• 3. Skull fracture

  Skull fracture는 골절 및 뇌손상을 일으키는 충분한 힘에 의해 발생하는 두개골의 골절이다. 기저두개골절은 두개골의 기저 부위에 선상골절이 있는 것으로, 정맥동을 지나 전두엽이나 측두엽의 경막이 손상되어 뇌척수액이 귀나 코로 누출될 수 있다. 증상으로는 뇌 신경 손상증상이 나타나며, X-ray, CT brain, skull series로 진단한다. 치료는 체액-전해질 균형 유지, 인지적 문제 평가 및 치료, 감염 예방 등이 필요하다.

• 4. Scapula fracture

  Scapula fracture는 외부적 힘에 의하여 견갑골의 골 조직의 연속성이 파괴된 상태이다. 충격이 심할 경우 발생하며, 동반손상으로 rib fracture, pneumothorax, hemothorax, lung contusion 등이 있을 수 있다. 증상으로는 변형, 부종, ecchymosis, muscle spasm, 통증, 감각 변화 등이 나타난다. 대부분 혈액 공급이 풍부하고 두꺼운 주의 근육들에 의해 골절부위가 안정화되므로 수술없이 치료가 가능하다.

• 5. Decompressive craniectomy

  Decompressive craniectomy는 두개골을 제거하여 두개골 내의 압력의 증가를 예방하는 수술이다. 뇌부종이 예상되면 일시적으로 두개골을 제거하여 두개골 내의 압력의 증가를 예방할 수 있다. 두개골을 제거했을 때 미용상 두개결손이 있으나 cranioplasty(두개골성형술)로 교정할 수 있다.

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• 1. Acute SDH(Acute subdural hemorrhage)

  Acute subdural hemorrhage (Acute SDH) is a serious and life-threatening condition that requires prompt medical attention. It occurs when blood accumulates between the dura mater and the arachnoid mater, causing increased intracranial pressure and potential brain damage. Acute SDH is often the result of traumatic brain injury, such as a severe head impact or a motor vehicle accident. Symptoms may include headache, confusion, drowsiness, and even coma. Immediate treatment is crucial, often involving surgical evacuation of the hematoma to relieve the pressure on the brain. Careful monitoring and management of intracranial pressure, as well as supportive care, are essential for improving outcomes. Prognosis can vary widely depending on the severity of the injury, the patient's age and overall health, and the timeliness of medical intervention. Ongoing research and advancements in neurosurgical techniques continue to improve the outlook for individuals suffering from acute SDH.

• 2. Traumatic SAH(Traumatic subarachinoid hemorrhage)

  Traumatic subarachnoid hemorrhage (tSAH) is a serious complication of traumatic brain injury, characterized by the presence of blood in the subarachnoid space. This condition can occur due to the rupture of cerebral blood vessels or the tearing of the arachnoid membrane, often as a result of a severe head injury, such as a motor vehicle accident or a fall. Symptoms of tSAH may include headache, altered mental status, and neurological deficits, depending on the location and extent of the bleeding. Prompt medical attention is crucial, as tSAH can lead to increased intracranial pressure, cerebral vasospasm, and other life-threatening complications. Treatment typically involves a combination of supportive care, management of intracranial pressure, and, in some cases, surgical intervention to address the underlying cause of the hemorrhage. Prognosis can vary widely, with factors such as the severity of the initial injury, the patient's age and overall health, and the timeliness of medical intervention all playing a role in the outcome. Ongoing research and advancements in neurosurgical techniques continue to improve the management and outcomes for individuals suffering from traumatic subarachnoid hemorrhage.

• 3. Skull fracture

  Skull fractures are a common consequence of traumatic brain injuries, ranging from minor cracks to more severe, complex fractures. These injuries can occur due to a variety of causes, such as falls, motor vehicle accidents, or physical assaults. The severity of a skull fracture depends on factors like the location, the extent of the fracture, and the presence of associated injuries, such as intracranial bleeding or brain tissue damage. Symptoms may include headache, swelling, bruising, or even visible deformities of the skull. Prompt medical evaluation and treatment are crucial, as skull fractures can increase the risk of complications like infection, cerebrospinal fluid leaks, and further brain injury. Treatment may involve conservative management, such as immobilization and monitoring, or surgical intervention to stabilize the fracture and address any underlying issues. Prognosis can vary widely, depending on the specific nature of the injury and the timely provision of appropriate medical care. Ongoing research and advancements in trauma management continue to improve outcomes for individuals suffering from skull fractures.

• 4. Scapula fracture

  Scapula fractures are relatively uncommon injuries, accounting for only about 1% of all fractures. They are typically the result of high-energy trauma, such as motor vehicle accidents or falls from a significant height. Scapula fractures can range in severity from isolated, non-displaced fractures to more complex, comminuted fractures involving the body, neck, or glenoid of the scapula. Symptoms may include shoulder pain, swelling, and limited range of motion. Prompt medical evaluation and appropriate treatment are essential, as scapula fractures can be associated with other serious injuries, such as rib fractures, lung contusions, or brachial plexus injuries. Treatment options may include conservative management with immobilization and physical therapy, or surgical intervention to stabilize the fracture and restore shoulder function. Prognosis for scapula fractures can be variable, depending on the specific fracture pattern, the presence of associated injuries, and the timely provision of appropriate medical care. Ongoing research and advancements in orthopedic trauma management continue to improve outcomes for individuals suffering from scapula fractures.

• 5. Decompressive craniectomy

  Decompressive craniectomy is a neurosurgical procedure performed to relieve increased intracranial pressure (ICP) in patients with severe traumatic brain injury, ischemic stroke, or other life-threatening conditions. The procedure involves the removal of a section of the skull, allowing the brain to expand and reducing the pressure within the confined space of the cranium. This can help prevent further brain damage and improve outcomes for patients. Decompressive craniectomy is typically considered a last resort when other medical and surgical interventions have failed to control ICP. The procedure carries significant risks, including infection, bleeding, and further neurological deficits, and the long-term outcomes can be variable. Careful patient selection, timing of the intervention, and comprehensive post-operative management are crucial factors in determining the success of decompressive craniectomy. Ongoing research and advancements in neurosurgical techniques, as well as a better understanding of the pathophysiology of elevated ICP, continue to refine the indications and improve the outcomes of this complex and challenging procedure.