The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses
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Review Comparative Study
Severe diffuse axonal injury in adults and children.
Diffuse axonal injury (DAI) occurs in 30% of all fatal head injuries. DAI is identified on autopsy as microscopic lesions that commonly appear in the splenium of the corpus callosum, rostral brainstem and frontal and temporal lobes of the cerebrum. ⋯ The most common mechanism for DAI is motor vehicle accidents. The neuroscience nurse needs to have an understanding of DAI anatomy and physiology, including the differences and similarities in the clinical presentation and neurologic functional outcome in both adult and pediatric populations.
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Investigation into the use of osmotic therapy for ICP reduction began in 1919. Mannitol is the osmotic agent currently in use. Mannitol's effectiveness in reducing ICP has been shown. ⋯ Lastly, mannitol may exert a protective effect against biochemical injury. The most common complications of therapy are fluid and electrolyte imbalances, cardiopulmonary edema and rebound cerebral edema. Nursing care of the patient receiving mannitol requires vigilant monitoring of electrolytes and overall fluid balance, and observation for the development of cardiopulmonary complications in addition to neurologic assessment.