traumatic head and spinal cord injury

MR.JERRY JAMES

NURSING EDUCATOR

INSTITUTE OF HEALTH ANDMANAGEMENT

TRAUMATIC HEAD AND SPINAL CORD INJURY

Deformation

Acceleration-deceleration

Rotation

MECHANISM OF INJURY

1.DIRECT HEAD INJURY

CLASSIFICATION OF HEAD INJURY

2. INDIRECT HEAD INJURY

OPEN HEAD INJURY

CLOSED HEAD INJURY

COUP AND COUNTERCOUP INJURY

1.SCALP INJURY

ABRASIONS

CONTUSIONS

LACERATION

CLASSIFICATION BASED ON THE LOCATION

2.SKULL FRACTURE

a. Linear fracture

b. Depressed skull fracture

c. Diastatic skull fracture

d. Basilar skull fracture

e. Cranial burst skull fracture

f. Compound skull fractures

2. MENINGEAL INJURIES

1.CONCUSSION

Typical signs.

• Altered level of consciousness

• Amnesia

• headache

2.CONTUSION

Typical signs

• Hemorrhage

• Infarction

• Necrosis

• Edema

• Seizure

• Increased I.C.P

3.CEREBRAL INJURIES

SPINAL CORD INJURY

1. Hyper flexion

2. Hyperextension

CLASSIFICATION OF SPINAL CORD INJURY

3. Compression injury

4.Rotational injuries

5.Penetrating injury

• COMPLETE INJURY

• INCOMPLETE INJURY

CLASSIFICATION BY DEGREE OF INJURY

1.Central cord syndrome

• Motor deficits in the upper extremities

• Less impairment in leg movements

• Sensory loss below the site of injury

• Loss of bladder control may occur

INCOMPLETE INJURY

2. Anterior cord syndromeLoss of perception of pain, temperature and motor

function is noted below the level of the lesion

3. Brown sequard syndrome

4. Conus medullaris and Cauda equina syndrome

• Lower extremity dysfunction

• Loss of bladder and anal sphincter

• function

• Male sexual dysfunction

• Loss of achilles reflex

Road traffic accident

Fall from higher place

Athletic accidents

Blast injuries

Anti coagulant and anti platelet medications

Occupational accidents

penetration

ETIOLOGICAL FACTORS

Brain suffers traumatic injury

Brain swelling or bleeding increase intra cranial volume

Intra cranial pressure increases

Pressure on blood vessels with in the brain increases

Decreased blood flow to the brain

Cerebral hypoxia and ischemia occur

Herniation of the brain

Brain death

PATHOPHYSIOLIOGY OF BRAIN TRAUMA

Hemorrhage

RBC and platelet break down of RBC

Aggregation

Free radical formation

Release of nor epinephrine

Serotonine,dopamine secondary injury

Vasoconstriction spinal edema, tissue hypoxia

Thrombosis formation

SC blood flow

PATHOPHYSIOLOGY OF SPINAL CORD INJURY

HEAD TRAUMA

Altered level of consciousness

Confusion

Pupillary abnormalities

Altered or absent gag and corneal reflex

Sudden onset of neurological onset

Changes in vital signs

Spasticity

Vertigo

Seizures

Ottorhoea

Rhinorrhoea

Slurred speech

CLINICAL MANIFESTATIONS

SPINAL CORD INJURY

Spinal shock and neurogenic shock

Respiratory distress

Bradycardia

Poikilothermism

Low blood pressure

Loss of bowel or bladder control

Loss of sensation, including the ability to feel heat, cold and touch

Difficulty with balance and walking

Loss of movement

Spinal edema

CERVICAL INJURIES

C-1/C-2 levels will often result in loss of breathing

C3 vertebrae and above : Typically results in loss of diaphragm function

C4 : Results in significant loss of function at the biceps and shoulders.

C5 : Results in potential loss of function at the biceps and shoulders, and complete loss of function at the wrists and hands.

C6 : Results in limited wrist control, and complete loss of hand function

C7 and T1 : Results in lack of dexterity in the hands and fingers, but allows for limited use of arms

THORACIC INJURIES

T1 to T8 : Results in the inability to control the abdominal muscles

T9 to T12 : Results in partial loss of trunk and abdominal muscle control.

LUMBOSACRAL INJURIES

Dysfunction of the bowel and bladder

Sexual dysfunction

Hisory collection

Physical examination

Neurological examination

Ct and m.R.I

Pet scan

Nerve conduction studies

Transcranial doppler studies

X ray

Blood investigation

DIAGNOSTIC FINDINGS

AMERICAN SPINAL INJURY ASSOCIATION SCALE

‘ASIA’ SCALE

A. Complete Complete loss of sensory and motor function

b. incomplete Sensory function is preserved but no motor function

c. incomplete Motor function is preserved and muscle grade more than 3

d. incomplete Motor function is preserved and muscle grade more than 3

e. normal Motor and sensory function are normal

2/2/2 rule

1. Patient die in 2 mins from airway and breathing compromise and hypovolemic shock

2. Patient die in 2 hrs from hypovolemic shock

3. Patient die in 2 weeks from septic shock

MANAGEMENT

Management of trauma patient can be divided in to 2 phase

• Primary phase

• Secondary phase

MANGEMENT

A - AIRWAY

B- BREATHING’

C- CIRCULATION

D- DISABILITY

E- EXPOSURE

PRIMARY SURVEY

AIRWAY

Assessment

Can the patient talk

Is the patient voice normal

Stridor

Foreign body

Bleeding and secretions

Mandibular or laryngeal fracture

INTERVENTIONS

1. Cervical spine stabilization

2. Sedation

3. Jaw thrust

4. Suction

5. Pulse oximetry

6. Oxygen administration

7. Endotracheal intubation

8. Arterial blood gas analysis

BREATHING

Assessment:

LOOK the movement of the chest

Respiratory rate

Flail chest

Cyanosis

Foreign object

INTERVENTIONS

• Oxygen administration

• Endotracheal intubation

• Arterial blood gas analysis

• Mechanical ventilation

• Inter costal drainage

SHOCK

Clinical findings

• Hypotension

• Tachycardia or bradycardia

• Tachypnea

CIRCULATION

CIRCULATION

ASSESSMENT

• External hemorrhage

• Penetrating trauma

• Blunt trauma

• Head injury

• hypotension

INTERVENTIONS

Intravenous fluids

Massive transfusion

Direct manual pressure

Hyperventilation

Mannitol

Anticonvulsants

positions

DISABILITY

Life threatening disability

• Spinal cord transection

• Intracerebral or intracranial hemorrhage

• Cerebro vascular injury

INTERVENTIONS

• Mobilization

• Neurological assessment

• Glasgow coma scale

‘AVPU’ ASSESSMENT

A- AWAKE

V-VERBAL RESPONSE

P-PAINFUL RESPONSE

U-UNRESPONSIVE

DISABILITY ASSESSMENT

EXPOSURE

Undress the patient and look for injury

Immobilization

Cover the patient with warm blanket

IV fluids

Patient privacy

LOG ROLLING

LIFTING AND HANDLING THE PATIENT

Step 1.

‘SAMPLE HISTORY’

S- signs and symptoms

A- allergies

M- medication currently used

P- past illness

L- last meal

E- events/ environment related injury

SECONDARY SURVEY

NURSING MANAGEMENT

Monitoring for neurological function

Maintaining the airway

Monitoring fluid and electrolyte balance

Promoting adequate nutrition

Preventing injury

Maintaining body temperature

Maintain skin integrity

• Drug management

Methylprednisolone (Medrol)

Atropine and dopamine

Anti coagulants

Sedatives

Analgesics

Osmotic diuretics

Deep vein thrombosis prophylaxis

I.V fluids

• Craniotomy or craniectomy

• Decompression laminectomy

NON SURGICAL MANAGEMENT

• The halo and vest system

• Cervical traction

SURGICAL MANAGEMENT