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Head Trauma
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Head Injuries: Account for about one half of all trauma
deaths Survivors range from baseline function to
severe morbidity Even “minor” head injury can have severe
impact As with most trauma, broken down into blunt
and penetrating
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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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Physiology of Nervous System Cerebral Blood Flow (CBF) = 50 – 55
ml/100g of brain tissue/minute Main Arterial Pressure (MAP) = Diast. P +
1/3 Pulse P Intracranial Pressure (ICP) = 10 mm Hg Cerebral Perfusion Pressure (CPP) = 50 -150
mm Hg 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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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 unreative 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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Brain Injuries Primary (Direct) Brain Injuries Secondary (Indirect) Injuries
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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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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.
Intracerebral 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 by NRM
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