Download Head Trauma

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the work of artificial intelligence, which forms the content of this project

Document related concepts
no text concepts found
Transcript
Head Trauma
Anatomy of Nervous System
 The nervous system is composed of
 Brain
 Spinal cord
 The nervous system is divided into:
 Central nervous system (Brain & Spinal Cord)
 Peripheral nervous system
Superior view of the skull
Physiology of Nervous System
 Cerebral Blood Flow (CBF)
 Main Arterial Pressure (MAP)
 Intracranial Pressure (ICP)
 Cerebral Perfusion Pressure (CPP)
 CPP = MAP – ICP
Injuries to the Brain & Skull
 Scalp injuries
 Skull injuries
 Brain injuries
Scalp Injuries
 Scalp has many blood vessels so injury may bleed profusely.
 Control bleeding with direct pressure.
 Don’t apply pressure when there is possible skull injury.
Anatomy of skull
Injuries to the scalp
Scalp injuries
Scalp injuries
Skull injuries
 It include fractures to the
cranium and the face,
can be associated with
brain injury.
 It is divided into:
 Open skull fracture:
cranium is fractures and
scalp is lacerated.
 Closed skull fracture:
scalp is lacerated but
cranium is intact.
 Basal skull fracture
S & S of Skull Fractures and Brain Injuries
 Visible bone fragments
 Altered mental status
 Deep lacerated or severe bruise or
hematoma
 Depression or deformity of the skull
 Severe pain at site of injury
 Battle’s Sign
 Unequal or unreactive pupils
 Raccoon’s eye
 Sunken eye
 Bleeding from the ears and/or nose
 Clear fluid flow from ears and/or
nose
 Personality change
 Increased blood pressure, decreased pulse
rate and widening pulse pressure (Cushing’s
Syndrome)
 Irregular breathing pattern
 Temperature increase
 Blurred or multiple vision
 Impaired hearing or ringing
 Equilibrium problems
 Forceful or projectile vomiting
 Posturing
 Paralysis or disability on one side of the
body
 Seizures
 Deteriorating vital signs
Battle’s sign
 Indication of fracture of middle
cranial fossa of the skull, and
may suggest underlying brain
trauma.
 It appears as a result
of extravasation of blood along
the path of the posterior
auricular artery
Raccoon eyes
 Raccoon eyes may be bilateral or
unilateral
 If unilateral, it is highly
suggestive of basilar skull
fracture, with a positive
predictive value of 85%
 Most often associated with
fractures of the anterior cranial
fossa.
CSF rhinorrhea & otorhea
 Suggestive of basal skull fracture
Brain Injuries
 Primary (Direct) Brain Injuries
 Secondary (Indirect) Injuries
Assessment of TBI
 ABC
 Alert Verbal Pain Unresponsive
 Vital signs
 GCS : Eye opening, Best motor response and Best verbal response
 History and mechanism of injury
Primary Brain Injuries
 It occur at the time of original insult
 Direct damage done to brain parenchyma and associated with
vascular injuries
 Brain tissue can be lacerated, punctured or bruised by broken bones
or foreign bodies
 Damage is already done
 Irreversible
 Damage control (debridement)
Secondary Brain Injury
 Damage that occurs after the initial insult (ongoing injury processes)
 Expanding mass lesions, swelling or bleeding quickly overwhelm
buffers
 End result is increased intracranial pressure (ICP) and/or herniation
 Diagnosis and treatments target minimizing the effects of these
indirect insults
Herniation
Herniation types
Secondary Injury Mechanisms
 Mass effect and subsequent elevated ICP and mechanical shifting
leading to herniation
 Hypoxia
 Hypotension and inadequate CBF
 Cellular mechanisms
Intracranial Causes
 Herniation: displaced brain parenchyma
 Damage to brain from trauma against the dura itself as well as producing
ischemia as well
 Cerebral Edema: intracellular fluid collection within neurons and
interstitial spaces.
 Intra-cerebral Hematomas
Brain Injuries – Brain Concussion
 Usually caused by blunt injuries.
 Injuries patient shows transient alteration in neurologic function
 Mild injury usually with no detectable brain damage.
 May have brief loss of consciousness.
 Headache grogginess and short memory loss are common.
Brain Injuries – Brain Contusion
 A bruised brain or contusion can occur with closed head injuries.
 Usually caused by blow that causes the brain to hit inside the skull
 Unconsciousness or decreased level of consciousness can occur
Brain Injuries – A hematoma
 Is a collection of blood within tissue.
 Hematoma inside the cranium is named according to its location:




Subdural hematoma: blood collection between brain and dura
Epidural hematoma: blood collection between dura and the skull
Subarachnoid Hemorrhage:
Intracerebral hematoma: blood collection within the brain
Epidural Hematomas
 Blood between
inner table of the
skull and the dura
 Lens shaped
hematomas that do
not cross suture
lines on CT
Subdural Hematomas
 Blood beneath the
dura, overlying the
brain and arachnoid,
resulting from tears to
bridging vessels
 Crescent shaped
density that may run
length of skull
 Very common in the
elderly
Subarachnoid Hemorrhage
 Bleeding beneath the arachnoid
membrane on the surface of the
brain.
Intracranial Hematoma
 Focal areas of
hemorrhage
within the
parenchyma
ER Care of Skull Fractures and Brain Injuries
 Take appropriate body substance
isolation precautions.
 Assume spine injury
 Monitor conscious patient for changes
in breathing
 Apply rigid collar, immobilize the neck
and spine
 Administer high concentration oxygen
 Control bleeding
 Keep patient at rest
 Talk to conscious patient (emotional
support)
 Dress and bandage open wounds
 Mange the patient for shock
 Be prepared for vomiting
 Transport patient promptly
 Monitor vital signs every five minutes