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Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
Brain And Craniofacial Trauma   Brenda
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Brain And Craniofacial Trauma Brenda

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Lt. Colonel Brenda Sowards, RN

Lt. Colonel Brenda Sowards, RN

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    • 1. Brain and Craniofacial Trauma Lt. Colonel Brenda Sowards, RN
    • 2. Head Trauma
      • 50-99% of moderate head trauma victims have permanent injury.
      • Motor Vehicle Crashes are primary cause.
      • Falls for elderly and children
      • High velocity missiles/blast injuries
      • 30% have at least one significant concurrent injury.
    • 3.  
    • 4. Pathophysiology
      • Primary brain injury
        • Direct Trauma
        • Involves bleeding, tearing, shearing, neuron damage
      • Secondary brain injury
        • Hypoxia, hypercapnea, hypotension, hyperglycemia, hypoglycemia, increased intracranial pressure, swelling, seizures
    • 5. Head Injuries
      • Scalp Lacerations
      • Skull Fractures
      • Concussions
      • Contusions
      • Intracranial Bleeding
      • Cerebral Edema
    • 6. Scalp Lacerations
      • Rich blood supply
      • Can cause hypovolemic shock
      • Often deeper brain injury has occurred
      • Direct pressure to control bleeding
      • Do not apply excessive pressure
      • Complete neurological exam
    • 7. Skull Fractures
      • Significant force has been applied to the skull.
      • Injuries from bullets, blasts,blunt force, other penetrating objects.
      • Risk of infection, if open skull fracture.
      • X-ray or CT
      • Deformity
      • Skull fragments
    • 8. Skull Fractures
      • Raccoon Eyes
        • Indicates maxilofacial fractures around eyes
        • Ecchymosis (Black eyes)
        • Visual Acuity
        • Eye bulges out (Exopthalmos)
        • Eye sinks in (Enopthalmos)
    • 9. Skull Fractures
      • Battle’s sign
        • Associated with basilar skull fracture
        • Blood accumulation behind one or both ears (forms bruising 12-24 hours later)
        • Hemotympanum
        • CSF drainage from ears or nose (never pack)
        • Check extraocular movements
    • 10. Concussion
      • Temporary loss of brain function
      • May result in loss of consciousness
      • Confusion
      • Amnesia
      • Dizzyness
      • Weakness
    • 11. Concussion
      • Coup- same side injury
      • Contra-coup-opposite side injury
      • Contusions may occur as the brain scrapes the inside of the skull
        • Bleeding, permanent injury, swelling, amnesia, unconsciousness
    • 12. Intracranial Bleeding
      • Epidural Hematoma
      • Subdural Hematoma
      • Intracerebral Hemorrhage
    • 13. Epidural Hematoma
      • Occurs above the dura lining
      • Occurs below the skull
      • Most often arterial bleeding
      • Develops rapidly
      • Rapid deterioration of neurologic functions
      • Lucid phase
    • 14. Subdural Hematomas
      • Occurs beneath the dura
      • Occurs outside the brain
      • Usually venous in nature
      • Develops slowly
      • Progressive loss of neurological function
      • Patients may not remember blunt trauma
    • 15. Intracranial Hemorrhage
      • Bleeding occurs within the brain itself
      • Caused by tearing, shearing of blood vessels
      • Spinal Taps contraindicated due to increased swelling
    • 16. Cerebral Edema
      • Most common complication of head injury
      • Aggravated by low oxygen levels
      • Seizures increase oxygen consumption
      • Causes increased intracranial pressure
      • Normal ICP 10-15 mm
    • 17. Cerebral Ischemia
      • Headache
      • Nausea and vomiting
      • Amnesia for events before or after injury
      • Altered level of consciousness
      • Restlessness, drowsiness
      • Changes in speech
      • Loss of judgement
    • 18. Intracranial Pressure
      • Cerebral Perfusion Pressure (CPP)
      • Mean Arterial Pressure (MAP)
      • Autoregulation
    • 19. Autoregulation
      • An increase in mean arterial pressure leads to vasoconstriction of cerebral vessels.
      • A decrease in mean arterial pressure leads to vasodilation of cerebral vessels.
      • Hypoxia and Hypovolemia are the main causes of secondary brain injury.
    • 20. Intracranial Pressure
      • Cerebral perfusion must be adequate to prevent secondary brain injury.
      • Prevention starts by treating shock.
      • Keep mean arterial pressure between 60 and 180 mm Hg.
      • One episode of hypotension significantly increases morbidity and mortality.
      • Position patient to facilitate venous drainage.
    • 21. Monro-Kellie Doctrine
    • 22. Glasgow Coma Scale EYE OPENING
      • Spontaneous
      • To Voice
      • To Pain
      • None
      • 4
      • 3
      • 2
      • 1
    • 23. Glasgow Coma Scale VERBAL RESPONSE
      • Oriented
      • Confused
      • Inappropriate Words
      • Incomprehensible Words
      • None
      • 5
      • 4
      • 3
      • 2
      • 1
    • 24. Glasgow Coma Scale MOTOR RESPONSE
      • Obeys Commands
      • Localizes Pain
      • Withdraws (pain)
      • Flexion (pain)
      • Extension (pain)
      • None
      • 6
      • 5
      • 4
      • 3
      • 2
      • 1
    • 25. Glasgow Coma Scale
      • Predicts mortality
      • Measures level of consciousness
      • Motor component most sensitive subset
      • Indicates improvement or deterioration
      • GCS of 9-15 indicates mild to moderate injury
      • GCS of 3-8 indicates severe head injury
    • 26. Pupil Assessment
      • Size
      • Light Response
      • Equal
      • Compare
    • 27. Posturing
      • Decorticate- hands turn inward toward
      • Decerebrate-hands turn outward
      • Happens prior to herniation syndrome.
    • 28. Treatment
      • Prevent secondary injury
      • Airway-oxygen and intubation if GCS < 8
      • Treat shock-normotensive
      • Hyperventilation is only indicated if patient shows signs of impending herniation
      • Control bleeding from other injuries
      • RAPID transport if possible
    • 29. Treatment
      • Continual assessment-pupils & GCS
      • Treat seizures-increased oxygen consumption of the brain
      • Watch for respiratory pattern changes-may indicate your patient is worsening.
    • 30. Management of Suspected Traumatic Brain Injury
    • 31. QUESTIONS ?

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