Head Trauma - PowerPoint Presentation

Slide1

Head TraumaSlide2

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 Slide3

Superior view of the skull Slide4

Physiology of Nervous System

Cerebral Blood Flow (CBF)

Main Arterial Pressure (MAP)

Intracranial Pressure (ICP)

Cerebral Perfusion Pressure (CPP)

CPP = MAP – ICPSlide5

Injuries to the Brain & Skull

Scalp injuries

Skull injuries

Brain injuries Slide6

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. Slide7

Anatomy of skull Slide8

Injuries to the scalp Slide9

Scalp injuries Slide10

Scalp injuries Slide11

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 Slide12

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 Slide13

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 arterySlide14

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.

Slide15

CSF rhinorrhea & otorhea

Suggestive of basal skull fracture Slide16

Brain Injuries

Primary (Direct) Brain Injuries

Secondary (Indirect) InjuriesSlide17

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 Slide18

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)Slide19

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 Slide20

Herniation Slide21

Herniation types Slide22

Secondary Injury Mechanisms

Mass effect and subsequent elevated ICP and mechanical shifting leading to herniation

Hypoxia

Hypotension and inadequate CBF

Cellular mechanisms Slide23

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 Slide24

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.Slide25

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 occurSlide26

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 brainSlide27

Epidural Hematomas

Blood between inner table of the skull and the dura

Lens shaped hematomas that do not cross suture lines on CTSlide28

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 elderlySlide29

Subarachnoid Hemorrhage

Bleeding beneath the arachnoid membrane on the surface of the brain. Slide30

Intracranial Hematoma

Focal areas of hemorrhage within the parenchymaSlide31

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