Brain Hypoxia and Brain Herniation (Nursing)

00:00 Okay, so we talked a little bit about Brain Hypoxia, but I wanted to come back and make sure I really highlighted that topic, because brain hypoxia, remember, every time, you see "hypo," and then it also refers to oxygen, it's low oxygen.

00:14 It's also known as hypoxic-ischemic brain injury.

00:17 We don't normally say that in regular conversation, but if you break that down, hypoxic-ischemic, that means that's why you had the damage, right? Low oxygen, ischemia, that tells us that we had the damage to the brain.

00:31 Now it's because the brain doesn't get enough oxygen, so this is commonly happens with drowning, choking, suffocating, or cardiac arrest.

00:41 Without that heart to pump oxygen around in the body, obviously, the brain isn't going to get fed or get what it needs.

00:48 So, when you have a drowning patient come in, these are usually pretty extreme.

00:53 Often it's children who-- Kids are so quick and so active.

00:58 You see this happen even when there's a lot of adults at the party and everyone was watching children.

01:02 They can slip into that pool pretty quickly.

01:05 So, these are very traumatic events.

01:07 So know that common causes of someone's brain not getting enough oxygen, could be drowning, particularly in the summertime.

01:16 Choking, people and children are really at risk for this, but adults can experience it, too.

01:21 Someone who is suffocated or who is in a cardiac arrest.

01:25 Now, why is brain herniation such an emergency? Well. remember, we talked about brain herniation a little bit in the intro.

01:33 But brain herniation is when inside the skull something causes such extreme pressure inside that skull that it moves those brain tissues into very inappropriate places, like through the holes in your skull.

01:47 It's most often the result of brain swelling from trauma or bleeding from a head injury that's inside the skull, or maybe had a stroke and that caused some swelling, or possibly even a brain tumor.

02:00 Because when a brain tumor even if it's benign, a brain tumor is extra mass inside your skull.

02:07 And think of-- Your skull is obviously hard and fixed.

02:10 Now when you have a little baby, they still have those suture lines and it's still growing and expanding.

02:15 But as adults, those are all fused.

02:18 It's meant to keep our head and our brain protected, but that means it doesn't have a lot of room for the average adult to have extra volume in there.

02:27 A brain tumor, even a benign brain tumor, is going to add extra volume inside this enclosed space.

02:35 So, extra mass, equals elevated intracranial pressure, puts the patient at a risk for brain herniation.

02:42 Remember, brain herniation is so serious, it could end up in death.

02:48 So I've got a drawing for you here and you can see that there's different places that your brain can exit the skull, right? It can push through those holes.

02:56 But it can cause brain death because it can cause irreversible brain stem dysfunction, or remember your brain stem is the one that tells you to like beat and breathe, your heart rate and your breathing.

03:08 So if my brain stem is irreparably damaged, then my respiratory system and my cardiovascular centers are not going to function.

03:17 I'm going to end up in respiratory or cardiac arrest.

03:20 I still remember the patients that I've had in ICU that we knew this was going to happen, we tried everything we could to prevent it.

03:28 But as you see it occurring, it is so frustrating, because you just seem and you feel so helpless because you are.

03:36 You can try and intervene, but you reach a certain point with some patients that this is going to happen, and you'll see the vital signs change as it does.

03:45 So, hopefully, you won't see this very often.

03:48 Hopefully, you'll be able to get to the patient in time.

03:51 They'll be able to have the kind of treatment that they need.

03:53 But this is what we're trying to avoid, brain herniation.

03:57 Look at those pupils up there.

04:00 When you look at their pupils and you see one is super big, we usually call that a blown pupil, how they're very different in size.

04:07 One is very small, one is very large.

04:10 This is a very ominous sign.