Riding out the storm: sympathetic storming after traumatic brain injury.
Riding out the storm: sympathetic storming after traumatic brain injury.
复制标题
DOI：
10.1097/01376517-200402000-00002
复制
发表时间：
2004-02
期刊：
影响因子：
--
通讯作者：
D. Lemke
中科院分区：
文献类型：
--
作者：
D. Lemke
急性多发性创伤后，交感神经系统和肾上腺的下丘脑刺激引起循环皮质激素和儿茶酚胺增加，或应激反应。在患有严重创伤性脑损伤或格拉斯哥昏迷量表评分为3-8分的个体中，这种反应可能被夸大和偶发。照顾这些人的护士常用的一个术语来描述这种现象是风暴。症状可包括意识水平改变、姿势增加、肌张力障碍、高血压、体温过高、心动过速、呼吸急促、出汗和激动。这些人通常处于低水平的神经活动，具有最低限度的警觉性，最低限度的意识和对刺激的反射性运动反应，并且风暴可以将看似和平的个体带入混乱状态。诊断通常仅基于临床评估，治疗旨在控制症状的持续时间和严重程度，并防止额外的脑损伤。风暴可能会给护士带来挑战，从在风暴高峰期为个人提供日常护理和治疗症状，到教育家庭。对患者的仔细评估会引导护士做出诊断，并将护士置于风暴事件的调节者角色，包括提供治疗和评估结果。
Following acute multiple trauma, hypothalamic stimulation of the sympathetic nervous system and adrenal glands causes an increase in circulating corticoids and catecholamines, or a stress response. In individuals with severe traumatic brain injury or a Glasgow Coma Scale score of 3-8, this response can be exaggerated and episodic. A term commonly used by nurses caring for these individuals to describe this phenomenon is storming. Symptoms can include alterations in level of consciousness, increased posturing, dystonia, hypertension, hyperthermia, tachycardia, tachypnea, diaphoresis, and agitation. These individuals generally are at a low level of neurological activity with minimal alertness, minimal awareness, and reflexive motor response to stimulation, and the storming can take a seemingly peaceful individual into a state of chaos. Diagnosis is commonly made solely on clinical assessment, and treatment is aimed at controlling the duration and severity of the symptoms and preventing additional brain injury. Storming can pose a challenge for the nurse, from providing daily care for the individual in the height of the storming episode and treating the symptoms, to educating the family. Careful assessment of the individual leads the nurse to the diagnosis and places the nurse in the role of moderator of the storming episode, including providing treatment and evaluating outcomes.