head trauma. anatomy of nervous system the nervous system is composed of brain spinal cord the...
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Head Trauma
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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
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Superior view of the skull
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Physiology of Nervous System
Cerebral Blood Flow (CBF) Main Arterial Pressure (MAP) Intracranial Pressure (ICP) Cerebral Perfusion Pressure (CPP) CPP = MAP – ICP
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Injuries to the Brain & Skull
Scalp injuries Skull injuries Brain injuries
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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.
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Anatomy of skull
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Injuries to the scalp
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Scalp injuries
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Scalp injuries
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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
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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
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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
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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.
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CSF rhinorrhea & otorhea
Suggestive of basal skull fracture
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Brain Injuries
Primary (Direct) Brain Injuries Secondary (Indirect) Injuries
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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
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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)
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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
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Herniation
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Herniation types
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Secondary Injury Mechanisms
Mass effect and subsequent elevated ICP and mechanical shifting leading to herniation
Hypoxia Hypotension and inadequate CBF Cellular mechanisms
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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
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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.
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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
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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
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Epidural Hematomas
Blood between inner table of the skull and the dura
Lens shaped hematomas that do not cross suture lines on CT
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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
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Subarachnoid Hemorrhage
Bleeding beneath the arachnoid membrane on the surface of the brain.
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Intracranial Hematoma
Focal areas of hemorrhage within the parenchyma
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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