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Head Trauma
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Head TraumaHead Trauma
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Head Trauma Facts:Head Trauma Facts:
• 40% of multiple trauma victims have brain injuries.
• Brain injured patients have a death rate twice that of non-brain injured patients.
• Head injuries account for 25% of all trauma deaths and 50% of motor vehicle fatalities.
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The SkullThe Skull
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Brain InjuryBrain Injury
• Most brain injuries are not from direct injury to the brain.
• Most occur as a result of external forces against the skull or from movement of the brain inside the skull.
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Deceleration InjuriesDeceleration Injuries
• The head strikes an object causing a sudden deceleration of the skull. The brain continues to travel forward and impacts the front of the skull.
• The brain then rebounds and strikes the rear of the skull.
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Coup / CountercoupCoup / Countercoup
• Coup is the original impact.
• Countercoup is the rebound impact.
COUP CONTRECOUP
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Skull FracturesSkull Fractures
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Brain InjuriesBrain Injuries
• Concussion
• Cerebral Contusion
• Intracranial Hemorrhage– ( bleeding inside the skull)
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Intracranial PressureIntracranial Pressure
• Injury to the brain can cause bleeding around the brain and/or swelling of the brain tissue.
• The brain cannot expand inside the skull, therefore pressure increases inside the skull - INTRACRANIAL
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As ICP Increases:As ICP Increases:
• Cerebral perfusion pressure =mean arterial pressure - ICP
• As ICP increases, the blood pressure increases in an attempt to maintain Cerebral Perfusion Pressure - Cushing Reflex
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Vital SignsVital Signs
Blood Pressure
Pulse
Respiration
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Assessment of the PatientAssessment of the Patient
• All patients with head or facial trauma have a cervical spine injury until proven otherwise!!
• Because head injured patients are often combative or have a decreased level of consciousness, a thorough assessment must be completed.
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Don’t Be Trapped?Don’t Be Trapped?
• Head injured patients are often under the influence of drugs and/or alcohol. Don’t let this influence your assessment and cause you to miss important information.
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AlsoAlso
• Head injured patients are also often uncooperative and/or aggressive even when not under the influence.
• Be patient and understanding! Resist making personal judgements about your patient.
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Signs and SymptomsSigns and Symptoms
• Mechanism of Injury
• Decreased level of Consciousness
• Bleeding or Fluid from Ears / Nose
• Watch the Vital Signs -Trend over Time
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Signs & Symptoms (cont)Signs & Symptoms (cont)
• Projectile Vomiting• Seizures• Unequal Pupils (late)• Hemiparesis - weakness or paralysis on one side of
the body• Posturing
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ManagementManagement
• C-Spine Immobilization• Airway management
– have suction available• High concentration oxygen or ventilate 12/min • Manage bleeding from scalp lacerations
– do not attempt to stop bleeding from
ears / nose
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Management (cont)Management (cont)
• Be prepared for seizures.
• If patient is on a backboard with C-Spine immobilization you can raise the head of the board slightly (4-6 inches) to possibly lower ICP.