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Brain and Craniofacial Trauma Lt. Colonel Brenda Sowards, RN
Head Trauma <ul><li>50-99% of moderate head trauma victims have permanent injury. </li></ul><ul><li>Motor Vehicle Crashes ...
 
Pathophysiology <ul><li>Primary brain injury </li></ul><ul><ul><li>Direct Trauma </li></ul></ul><ul><ul><li>Involves bleed...
Head Injuries <ul><li>Scalp Lacerations </li></ul><ul><li>Skull Fractures </li></ul><ul><li>Concussions </li></ul><ul><li>...
Scalp Lacerations <ul><li>Rich blood supply </li></ul><ul><li>Can cause hypovolemic shock </li></ul><ul><li>Often deeper b...
Skull Fractures <ul><li>Significant force has been applied to the skull. </li></ul><ul><li>Injuries from bullets, blasts,b...
Skull Fractures <ul><li>Raccoon Eyes </li></ul><ul><ul><li>Indicates maxilofacial fractures around eyes </li></ul></ul><ul...
Skull Fractures <ul><li>Battle’s sign </li></ul><ul><ul><li>Associated with basilar skull fracture </li></ul></ul><ul><ul>...
Concussion <ul><li>Temporary loss of brain function </li></ul><ul><li>May result in loss of consciousness </li></ul><ul><l...
Concussion <ul><li>Coup- same side injury </li></ul><ul><li>Contra-coup-opposite side injury </li></ul><ul><li>Contusions ...
Intracranial Bleeding <ul><li>Epidural Hematoma </li></ul><ul><li>Subdural Hematoma </li></ul><ul><li>Intracerebral Hemorr...
Epidural Hematoma <ul><li>Occurs above the dura lining   </li></ul><ul><li>Occurs below the skull   </li></ul><ul><li>Most...
Subdural Hematomas <ul><li>Occurs beneath the dura </li></ul><ul><li>Occurs outside the brain </li></ul><ul><li>Usually ve...
Intracranial Hemorrhage <ul><li>Bleeding occurs within the brain itself </li></ul><ul><li>Caused by tearing, shearing of b...
Cerebral Edema <ul><li>Most common complication of head injury </li></ul><ul><li>Aggravated by low oxygen levels </li></ul...
Cerebral Ischemia <ul><li>Headache </li></ul><ul><li>Nausea and vomiting </li></ul><ul><li>Amnesia for events before or af...
Intracranial Pressure <ul><li>Cerebral Perfusion Pressure (CPP) </li></ul><ul><li>Mean Arterial Pressure (MAP) </li></ul><...
Autoregulation <ul><li>An increase in mean arterial pressure leads to vasoconstriction of cerebral vessels. </li></ul><ul>...
Intracranial Pressure <ul><li>Cerebral perfusion must be adequate to prevent secondary brain injury. </li></ul><ul><li>Pre...
Monro-Kellie Doctrine
Glasgow Coma Scale EYE OPENING <ul><li>Spontaneous </li></ul><ul><li>To Voice </li></ul><ul><li>To Pain </li></ul><ul><li>...
Glasgow Coma Scale VERBAL RESPONSE <ul><li>Oriented </li></ul><ul><li>Confused </li></ul><ul><li>Inappropriate Words </li>...
Glasgow Coma Scale MOTOR RESPONSE <ul><li>Obeys Commands </li></ul><ul><li>Localizes Pain </li></ul><ul><li>Withdraws (pai...
Glasgow Coma Scale <ul><li>Predicts mortality </li></ul><ul><li>Measures level of consciousness </li></ul><ul><li>Motor co...
Pupil Assessment <ul><li>Size  </li></ul><ul><li>Light Response </li></ul><ul><li>Equal </li></ul><ul><li>Compare  </li></ul>
Posturing <ul><li>Decorticate- hands turn inward toward  </li></ul><ul><li>Decerebrate-hands turn outward </li></ul><ul><l...
Treatment <ul><li>Prevent secondary injury </li></ul><ul><li>Airway-oxygen and intubation if GCS < 8 </li></ul><ul><li>Tre...
Treatment <ul><li>Continual assessment-pupils & GCS </li></ul><ul><li>Treat seizures-increased oxygen consumption of the b...
Management of Suspected Traumatic Brain Injury
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Brain Injury

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  • Transcript of "Brain Injury"

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