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Head injuries Overview

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Definition, Types, Anatomy,Mechanisms, Injuries, Hematomas, Fractures, Signs & Symptoms, Diagnosis, Glasgow Coma Scale, Treatment, Complications, Prevention

Publicado en: Salud y medicina
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Head injuries Overview

  1. 1. CROSS-SECTION
  2. 2. HEAD INJURY - DEFINITION • Any injury that results in trauma to the SCALP, SKULL or BRAIN. • TRAUMATIC BRAIN INJURY and HEAD INJURY are often used interchangeably.
  3. 3. HEAD INJURY - TYPES OPEN HEAD INJURY: There is penetration to the skull. CLOSED HEAD INJURY There is NO penetration to the skull.
  4. 4. COUP-CONTRECOUP INJURIES • Damage may occur directly under the site of impact (COUP), or it may occur on the side opposite the impact (CONTRECOUP).
  5. 5. HEAD INJURY - MECHANISMS PRIMARY INTRACRANIAL INJURY • It is the initial neuronal damage that occurs IMMEDIATELY as result of trauma. SECONDARY INTRACRANIAL INJURY • Secondary injuries are the result of the neurophysiological and anatomic changes, which occur from MINUTES to DAYS after the original trauma.
  6. 6. HEAD INJURY - MECHANISMS PRIMARY INTRACRANIAL INJURY • Cerebral Laceration • Cerebral Contusion • Epidural Hematoma • Subdural Hematoma • Subarachnoid Hematoma • Intracerebral Hematoma • Diffuse Axonal Injury SECONDARY INTRACRANIAL INJURY • Edema • Impaired Metabolism • Altered Cerebral Blood Flow • Free Radical Formation • Excitotoxicity
  7. 7. SCALP INJURIES LACERATIONS SUBGALEAL HEMATOMA
  8. 8. SKULL INJURIES CLOSED FRACTURES • A closed fracture has a significant chance of associated intracranial haematoma. OPEN FRACTURES • Open fractures have potential for serious infection. • Any foreign matter impaled in the skull should be left in place for removal by the neurosurgeons. • Cover it lightly with a sterile dressing that has been moistened with a sterile saline.
  9. 9. SKULL INJURIES CT SCAN OT
  10. 10. SKULL INJURIES DEPRESSED FRACTURES/COMPOUND DEPRESSED FRACTURES NON-DEPRESSED LINEAL FRACTURES
  11. 11. SKULL INJURIES - BASILAR SKULL FRACTURE
  12. 12. SKULL INJURIES - BASILAR SKULL FRACTURE RACCOON EYE
  13. 13. SKULL INJURIES - BASILAR SKULL FRACTURE BATTLE’S SIGN
  14. 14. SKULL INJURIES - BASILAR SKULL FRACTURE BLEEDING FROM THE EAR CANAL CSF LEAKAGE FROM THE EAR OR NOSE
  15. 15. BRAIN INJURIES DIFFUSE • Concussion • Diffuse Axonal Injury FOCAL • Contusion • Brain Lacerations • Epidural haematoma • Subdural haematoma • Subarachnoid haemorrhage • Parenchymal haematoma
  16. 16. HEAD INJURY (DIFFUSE) - CONCUSSION • Brain injury that does not result in any evidence of structural alteration. • Return of consciousness moments or minutes after impact. • There may be brief confusion, disorientation, headache, dizziness, amnesia. • CT scan is normal.
  17. 17. HEAD INJURY (DIFFUSE) - DIFFUSE AXONAL INJURY
  18. 18. BRAIN CONTUSION
  19. 19. EPIDURAL HEMATOMA SCHEMATIC CT SCAN
  20. 20. SUBDURAL HEMATOMA SCHEMATIC CT SCAN
  21. 21. SUBARACHNOID HEMATOMA SCHEMATIC CT SCAN
  22. 22. INTRACEREBRAL HEMATOMA SCHEMATIC CT SCAN
  23. 23. HEMATOMAS
  24. 24. CEREBRAL EDEMA NORMAL CT SCAN CEREBRAL EDEMA
  25. 25. SIGNS A sign of ↑ICP (INTRACRANIAL PRESSURE) CUSHING REFLEX ↑ Blood Pressure ↓ Pulse Rate ↓ Respiratory Rate
  26. 26. SIGNS • A UNILATERAL , FIXED DILATED PUPIL indicates neurologic deterioration may be secondary to hypoxia, hypovolaemia or hypoglycaemia, due to ↑ICP, and compression of the 3rd Cranial Nerve (OCULOMOTOR NERVE). DILATED PUPIL
  27. 27. SIGNS
  28. 28. SIGNS DECORTICATE POSTURING • Arms Flexed • Arms bent inward on the chest • Hands clenched into fists • Legs Extended • Feet turned Inward • Score of 3 in the Motor section of the Glasgow Coma Scale
  29. 29. SIGNS DECEREBRATE POSTURING • Head is arched back • Arms Extended by the sides • Legs Extended • Patient is rigid with the teeth clenched. • Score of 2 in the Motor section of the Glasgow Coma Scale
  30. 30. SYMPTOMS • Confusion/Irritibility • Drowsiness • Dizziness • Nausea & Vomiting • Amnesia • Speech/Swallowing Difficulty • CSF Leakage • Ear Bleeding • Numbness/Paralysis • Coma
  31. 31. SYMPTOMS
  32. 32. SYMPTOMS
  33. 33. DIAGNOSIS HISTORY PHYSICAL EXAMINATION HEAD & NEUROLOGIC EXAM CT SCAN
  34. 34. DIAGNOSIS - HISTORY PATIENT PEOPLE
  35. 35. DIAGNOSIS - PHYSICAL EXAMINATION ABCDE • A = AIRWAY • B = BREATHING • C = CIRCULATION • D = DISABILITY • E = EXPOSURE • GLASGOW COMA SCALE (GCS) • SYSTEMIC EXAMINATION
  36. 36. GLASGOW COMA SCALE MINIMUM=3/15 MAXIMUM=15/15 INTUBATION <8/15
  37. 37. GLASGOW COMA SCALE (GCS) SEVERITY SCORE 13-15 9-12 3-8 MILD MODERATE SEVERE
  38. 38. GLASGOW COMA SCALE (GCS) SEVERITY LOSS OF CONSCIOUSNESS 0-30 mins >30 mins to <24 hrs >24 hrs MILD MODERATE SEVERE
  39. 39. DIAGNOSIS - HEAD AND NEUROLOGIC EXAM HEAD EXAM • Hematoma • Contusion • Fracture e.g. Basilar Skull Fracture • Laceration NEUROLOGIC EXAM • Cranial Nerves • Muscle Tone • Muscle Power • Sensations • Walking Gait
  40. 40. DIAGNOSIS - OTHERS X-RAYS / MRI ANGIOGRAPHY EEG TRANSCRANIAL DOPPLER
  41. 41. TREATMENT ACUTE STAGE CHRONIC STAGE
  42. 42. TREATMENT - ACUTE STAGE CERVICAL IMMOBILIZATION • Philadelphia Collar
  43. 43. TREATMENT - ACUTE STAGE (AIRWAY) ENDOTRACHEAL INTUBATION • If intubation is impossible: Laryngeal Mask or Cricothyrotomy are indicated. SIGNS OF ↓OXYGEN • Respiratory rate < 10 or >40 bpm. • S02 <90% breathing oxygen or <85% breathing air • Hypercarbia that implies pH<7.2 • Hypoxia Pa02<50 mm Hg
  44. 44. TREATMENT - ACUTE STAGE (AIRWAY) LARYNGEAL MASK
  45. 45. TREATMENT - ACUTE STAGE (AIRWAY) CRICOTHYROTOMY
  46. 46. TREATMENT - ACUTE STAGE (AIRWAY) ENDOTRACHEAL INTUBATION • Rapid sequence intubation is performed, using sedative agents and muscle relaxants. MECHANICAL VENTILATION STANDARD PARAMETERS • Tidal Volume: 8-10 ml/kg • Rate: 12-15 bpm • Pressure: 15-20 cm H20 • Fi02: 1
  47. 47. TREATMENT - ACUTE STAGE (BREATHING) • Start high-flow oxygen administration (10-12 l/min)
  48. 48. TREATMENT - ACUTE STAGE (CIRCULATION) • Establish IV access with two large-bore(14- or16 gauge) IV cannulas. • IV infusion of Normal Saline (NS). • IV Norepinephrine • AVOID giving 5% Dextrose unless hypoglycaemia is present. • Dextrose ↑cerebral oedema • If BP is normal AVOID giving excessive volumes of fluids that may ↑cerebral oedema.
  49. 49. TREATMENT - ACUTE STAGE (DISABILITY) TREATMENT FOR ↑ICP • IV Mannitol (Osmotic Diuretic) • IV Furosemide • Hyperventilation
  50. 50. TREATMENT - ACUTE STAGE (DISABILITY) TREATMENT FOR ↑ICP • If there are no counter- indications (hypovolaemia, spine injury) place the patient in “Reverse-Trendelenburg” position REVERSE-TRENDELENBURG
  51. 51. TREATMENT - ACUTE STAGE (DISABILITY) • If significant agitation and after excluding hypoxia, hypovolaemia or pain, as the cause of agitation: IV Midazolam
  52. 52. TREATMENT - ACUTE STAGE (EXPOSURE) • AVOID ↓Body Temperature • ↑Body Temperature: Cooling measures and IV Paracetamol • Pain medication: IV Fentanyl • Anti-Emetics • Post-Traumatic Seizures: IV Diazepam
  53. 53. TREATMENT - ACUTE STAGE (PARAMETERS) MONITOR • Blood Pressure • Heart Rate • Respiratory Rate • S02, Etc02 • ECG BLOOD SAMPLES • Serum Electrolytes • Arterial Blood Gas • Hyper/Hypoglycaemia
  54. 54. TREATMENT - ACUTE STAGE (CATHETERIZATION) NASOGASTRIC TUBE • Place a Nasogastric tube (NG Tube) to decompress the stomach and reduce the risk of vomiting as aspiration. • AVOID NG Tube for patients with facial injuries. The tube could enter the brain through a bony fracture.
  55. 55. TREATMENT - ACUTE STAGE (CATHETERIZATION) URINARY CATHETER • Insert an indwelling urinary catheter for hourly urine output monitoring. • AVOID insertion if injury is suspected to the urethra.
  56. 56. TREATMENT - ACUTE STAGE (SURGERY) DECOMPRESSIVE CRANIOTOMY
  57. 57. TREATMENT - CHRONIC STAGE REHABILITATION Physiotherapy Neurologists Occupational Therapy Speech and Language Therapy Psychologists/Psychiatrists
  58. 58. COMPLICATIONS • Personality Changes • Hypopituitarism e.g. DI • Post-Traumatic Seizures • Infections e.g. Meningitis • Vasospasm, Aneurysm • Coma, Brain Death LONG-TERM EFFECTS • Parkinson’s • Alzheimer’s Dementia
  59. 59. PREVENTION HELMETS SEAT BELTS FALLS IN THE ELDERLY RESTRICTING ALCOHOL USE

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