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HEAD TRAUMA 1 HEAD TRAUMA Instructor Name: Title: Unit:
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HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

Dec 29, 2015

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Page 1: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

HEAD TRAUMA

1

HEAD TRAUMAHEAD TRAUMA

Instructor Name:

Title:

Unit:

Page 2: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

OVERVIEWOVERVIEW

• Anatomy of skull and brain• Pathophysiology of head injury• Review of specific head injuries• Assessment of head trauma• Management of head trauma

Page 3: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

HEAD INJURYHEAD INJURY

• Cause of death in 25% of trauma patients• Cause of death in 50% of MVCs• Significant long term disability• Prompt recognition and treatment can

improve outcome• All patients with head or facial trauma have

c-spine injury until proven otherwise

Page 4: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

ANATOMYANATOMY

Page 5: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

BRAIN INJURYBRAIN INJURY

• Brain injury results from:– Direct injury to brain tissue– External forces applied to

outside of skull transmitted to the brain

– Movement of brain inside skull

Page 6: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

COUP CONTRACOUPCOUP CONTRACOUP

• “4 collision” concept– Auto strikes tree

– Head strikes windshield

– Brain strikes inside of frontal skull

– Brain rebounds and hits inside of occipital skull

Page 7: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

PRIMARY vs. SECONDARY

BRAIN INJURY

PRIMARY vs. SECONDARY

BRAIN INJURY

• Primary injury is immediate from bruising or penetrating objects

• Secondary injury is from hypoxia or perfusion of the brain– Caused by swelling, hypoxia, or

hypotension– May be prevented by good patient care– Hyperventilation decreases perfusion of the

brain tissue– Protect airway, give oxygen, maintain BP

Page 8: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

HEAD INJURIESSCALP WOUNDSHEAD INJURIESSCALP WOUNDS

• Very vascular• Bleed briskly• Most scalp bleeding can

be controlled with direct pressure

Page 9: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

HEAD INJURIESSKULL INJURIESHEAD INJURIESSKULL INJURIES

Courtesy Roy Alson, MD

Page 10: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

SIGNS OF BASILAR SKULL FRACTURE

SIGNS OF BASILAR SKULL FRACTURE

Courtesy David Effron, M.D.Courtesy David Effron, M.D.

Page 11: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

HEAD INJURIES BRAIN INJURIESHEAD INJURIES BRAIN INJURIES

• Concussion• Cerebral contusion• Diffuse axonal

injury• Anoxic brain injury

Page 12: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

HEAD INJURIESEPIDURAL HEMATOMA

HEAD INJURIESEPIDURAL HEMATOMA

Page 13: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

HEAD INJURIES SUBDURAL HEMATOMA

HEAD INJURIES SUBDURAL HEMATOMA

Page 14: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

HEAD INJURIES INTRACRANIAL HEMORRHAGE

HEAD INJURIES INTRACRANIAL HEMORRHAGE

Page 15: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

ASSESSMENT RAPID TRAUMA SURVEY

ASSESSMENT RAPID TRAUMA SURVEY

• Note LOC (AVPU), secure airway and protect c-spine

• Assess breathing– Do not allow the patient to become hypoxic

• Assess circulation– Control major bleeding– Prevent hypotension

• Transport decision and interventions• Do brief neuro & GCS if altered LOC

Page 16: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

ASSESSMENT DETAILED EXAM

ASSESSMENT DETAILED EXAM

• Vital signs• SAMPLE history• Head-to-toe exam, including neurological

and GCS• Further bandaging and splinting• Continuous observation

Page 17: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

PUPILSPUPILS

Page 18: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

POSTURINGPOSTURING

Page 19: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

MANAGEMENT OF THE HEAD TRAUMA PATIENTMANAGEMENT OF THE

HEAD TRAUMA PATIENT

• Stabilize the c-spine• Secure and maintain the airway• Ventilate at about 15 breaths/min.• Prevent hypoxia• Hyperventilate only patients with the

herniation syndrome– Coma, BP, Respiration, bradycardia

Page 20: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

HEAD TRAUMA

19

AIRWAY CONTROL CANNOT BE OVEREMPHASIZED

AIRWAY CONTROL CANNOT BE OVEREMPHASIZED

Page 21: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

MANAGEMENT MANAGEMENT

• Record baseline exam– Neuro, GCS & pupils– Vital signs

• Maintain good circulation– BP 110-120 systolic

• Continually monitor and record observations

• Prompt transport

Page 22: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

PITFALLS & PROBLEMSPITFALLS & PROBLEMS

• Anticipate c-spine injuries• Protect the airway - prevent

aspiration• Prevent hypoxia• Prevent shock

– IV fluids and PASG are OK

Page 23: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

PITFALLS & PROBLEMS PITFALLS & PROBLEMS

• Be prepared for seizures• Rapidly deteriorating condition

requires rapid hospital treatment• Assess for other causes of altered

LOC– Hypoglycemia– Alcohol– Drugs

Page 24: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

SUMMARYSUMMARY

• Follow patient assessment• Protect c-spine, airway, and circulation• Record frequent vital signs, neuro, pupils,

and GCS• Prompt transport

Page 25: HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.

QUESTIONS?QUESTIONS?