Traumatic head and spinal cord injury

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Traumatic head and spinal cord injury

  1. 1. TRAUMATIC HEAD AND SPINAL CORD INJURY MR.JERRY JAMES NURSING EDUCATOR INSTITUTE OF HEALTH ANDMANAGEMENT
  2. 2. MECHANISM OF INJURY Deformation Acceleration-deceleration Rotation
  3. 3. CLASSIFICATION OF HEAD INJURY 1.DIRECT HEAD INJURY
  4. 4. 2. INDIRECT HEAD INJURY
  5. 5. OPEN HEAD INJURY
  6. 6. CLOSED HEAD INJURY
  7. 7. COUP AND COUNTERCOUP INJURY
  8. 8. CLASSIFICATION BASED ON THE LOCATION 1.SCALP INJURY  ABRASIONS  CONTUSIONS  LACERATION
  9. 9. 2.SKULL FRACTURE a. Linear fracture
  10. 10. b. Depressed skull fracture
  11. 11. c. Diastatic skull fracture
  12. 12. d. Basilar skull fracture
  13. 13. e. Cranial burst skull fracture
  14. 14. f. Compound skull fractures
  15. 15. 2. MENINGEAL INJURIES
  16. 16. 3.CEREBRAL INJURIES 1.CONCUSSION Typical signs. • Altered level of consciousness • Amnesia • headache 2.CONTUSION Typical signs • Hemorrhage • Infarction • Necrosis • Edema • Seizure • Increased I.C.P
  17. 17. SPINAL CORD INJURY
  18. 18. CLASSIFICATION OF SPINAL CORD INJURY 1. Hyper flexion 2. Hyperextension
  19. 19. 3. Compression injury
  20. 20. 4.Rotational injuries
  21. 21. 5.Penetrating injury
  22. 22. CLASSIFICATION BY DEGREE OF INJURY • COMPLETE INJURY • INCOMPLETE INJURY
  23. 23. INCOMPLETE INJURY 1.Central cord syndrome • Motor deficits in the upper extremities • Less impairment in leg movements • Sensory loss below the site of injury • Loss of bladder control may occur
  24. 24. 2. Anterior cord syndrome Loss of perception of pain, temperature and motor function is noted below the level of the lesion
  25. 25. 3. Brown sequard syndrome
  26. 26. 4. Conus medullaris and Cauda equina syndrome • Lower extremity dysfunction • Loss of bladder and anal sphincter • function • Male sexual dysfunction • Loss of achilles reflex
  27. 27. ETIOLOGICAL FACTORS Road traffic accident Fall from higher place Athletic accidents Blast injuries Anti coagulant and anti platelet medications Occupational accidents penetration
  28. 28. PATHOPHYSIOLIOGY OF BRAIN TRAUMA Brain suffers traumatic injury Brain swelling or bleeding increase intra cranial volume Intra cranial pressure increases Pressure on blood vessels with in the brain increases Decreased blood flow to the brain Cerebral hypoxia and ischemia occur Herniation of the brain Brain death
  29. 29. PATHOPHYSIOLOGY OF SPINAL CORD INJURY Hemorrhage RBC and platelet break down of RBC Aggregation Free radical formation Release of nor epinephrine Serotonine,dopamine Vasoconstriction Thrombosis formation SC blood flow secondary injury spinal edema, tissue hypoxi a
  30. 30. CLINICAL MANIFESTATIONS HEAD TRAUMA  Altered level of consciousness  Confusion  Pupillary abnormalities  Altered or absent gag and corneal reflex  Sudden onset of neurological onset  Changes in vital signs  Spasticity  Vertigo  Seizures  Ottorhoea  Rhinorrhoea  Slurred speech
  31. 31. SPINAL CORD INJURY Spinal shock and neurogenic shock Respiratory distress Bradycardia Poikilothermism Low blood pressure Loss of bowel or bladder control Loss of sensation, including the ability to feel heat, cold and touch Difficulty with balance and walking Loss of movement Spinal edema
  32. 32. CERVICAL INJURIES C-1/C-2 levels will often result in loss of breathing C3 vertebrae and above : Typically results in loss of diaphragm function C4 : Results in significant loss of function at the biceps and shoulders. C5 : Results in potential loss of function at the biceps and shoulders, and complete loss of function at the wrists and hands. C6 : Results in limited wrist control, and complete loss of hand function C7 and T1 : Results in lack of dexterity in the hands and fingers, but allows for limited use of arms
  33. 33. THORACIC INJURIES T1 to T8 : Results in the inability to control the abdominal muscles T9 to T12 : Results in partial loss of trunk and abdominal muscle control. LUMBOSACRAL INJURIES Dysfunction of the bowel and bladder Sexual dysfunction
  34. 34. DIAGNOSTIC FINDINGS Hisory collection Physical examination Neurological examination Ct and m.R.I Pet scan Nerve conduction studies Transcranial doppler studies X ray Blood investigation
  35. 35. ‘ASIA’ SCALE AMERICAN SPINAL INJURY ASSOCIATION SCALE A. Complete Complete loss of sensory and motor function b. incomplete Sensory function is preserved but no motor function c. incomplete Motor function is preserved and muscle grade more than 3 d. incomplete Motor function is preserved and muscle grade more than 3 e. normal Motor and sensory function are normal
  36. 36. MANAGEMENT 2/2/2 rule 1. Patient die in 2 mins from airway and breathing compromise and hypovolemic shock 2. Patient die in 2 hrs from hypovolemic shock 3. Patient die in 2 weeks from septic shock
  37. 37. MANGEMENT Management of trauma patient can be divided in to 2 phase • Primary phase • Secondary phase
  38. 38. PRIMARY SURVEY A - AIRWAY B- BREATHING’ C- CIRCULATION D- DISABILITY E- EXPOSURE
  39. 39. AIRWAY Assessment  Can the patient talk  Is the patient voice normal  Stridor  Foreign body  Bleeding and secretions  Mandibular or laryngeal fracture
  40. 40. INTERVENTIONS 1. Cervical spine stabilization 2. Sedation 3. Jaw thrust 4. Suction 5. Pulse oximetry 6. Oxygen administration 7. Endotracheal intubation 8. Arterial blood gas analysis
  41. 41. BREATHING Assessment: LOOK the movement of the chest Respiratory rate Flail chest Cyanosis Foreign object
  42. 42. INTERVENTIONS • Oxygen administration • Endotracheal intubation • Arterial blood gas analysis • Mechanical ventilation • Inter costal drainage
  43. 43. CIRCULATION SHOCK Clinical findings • Hypotension • Tachycardia or bradycardia • Tachypnea
  44. 44. CIRCULATION ASSESSMENT • External hemorrhage • Penetrating trauma • Blunt trauma • Head injury • hypotension
  45. 45. INTERVENTIONS Intravenous fluids Massive transfusion Direct manual pressure Hyperventilation Mannitol Anticonvulsants positions
  46. 46. DISABILITY Life threatening disability • Spinal cord transection • Intracerebral or intracranial hemorrhage • Cerebro vascular injury INTERVENTIONS • Mobilization • Neurological assessment • Glasgow coma scale
  47. 47. DISABILITY ASSESSMENT ‘AVPU’ ASSESSMENT A- AWAKE V-VERBAL RESPONSE P-PAINFUL RESPONSE U-UNRESPONSIVE
  48. 48. EXPOSURE Undress the patient and look for injury Immobilization Cover the patient with warm blanket IV fluids Patient privacy
  49. 49. LIFTING AND HANDLING THE PATIENT LOG ROLLING
  50. 50. SECONDARY SURVEY Step 1. ‘SAMPLE HISTORY’ S- signs and symptoms A- allergies M- medication currently used P- past illness L- last meal E- events/ environment related injury
  51. 51. NURSING MANAGEMENT Monitoring for neurological function Maintaining the airway Monitoring fluid and electrolyte balance Promoting adequate nutrition Preventing injury Maintaining body temperature Maintain skin integrity
  52. 52. • Drug management Methylprednisolone (Medrol) Atropine and dopamine Anti coagulants Sedatives Analgesics Osmotic diuretics Deep vein thrombosis prophylaxis I.V fluids
  53. 53. SURGICAL MANAGEMENT • Craniotomy or craniectomy • Decompression laminectomy NON SURGICAL MANAGEMENT • The halo and vest system • Cervical traction

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