This document provides an overview of anatomy, physiology, and pathophysiology related to head, facial, and neck trauma. It begins with detailed anatomy and physiology sections covering the brain, cranial nerves, vasculature, structures of the head, face, neck, and related systems. It then discusses pathophysiology of injuries including scalp lacerations, skull fractures, direct and indirect brain injuries such as contusions and hemorrhages. Signs and symptoms of increasing intracranial pressure and herniation are outlined. Management priorities for head and facial trauma are also reviewed.
The most common cause of death in young is non other than Head injury. The modern advances not only gave human mankind a luxury but with high velocity injury there is high burden of head injury too. This slide is updated with BTF 2016 guideline
The most common cause of death in young is non other than Head injury. The modern advances not only gave human mankind a luxury but with high velocity injury there is high burden of head injury too. This slide is updated with BTF 2016 guideline
Emergency management of patients with facial traumaAhmed Adawy
Emergency management of patients with facial trauma
Dr. Ahmed M. Adawy Professor Emeritus, Dept. Oral & Maxillofacial Surg. Former Dean, Faculty of Dental Medicine
Al-Azhar University.
Maxillofacial trauma is without doubt a most challenging area within the specialty of oral and maxillofacial surgery. As with all traumas, basic Advanced Trauma Life Support principles (ATLS) should be applied to the initial assessment of the casualty. The primary survey is given by the letters ABCDE.
• Airway maintenance with cervical spine protection.
• Breathing and ventilation.
• Circulation with hemorrhage control.
• Disability: neurological status.
• Exposure/environmental control - undress the patient but prevent hypothermia.
Each was explored and discussed.
Emergency management of patients with facial traumaAhmed Adawy
Emergency management of patients with facial trauma
Dr. Ahmed M. Adawy Professor Emeritus, Dept. Oral & Maxillofacial Surg. Former Dean, Faculty of Dental Medicine
Al-Azhar University.
Maxillofacial trauma is without doubt a most challenging area within the specialty of oral and maxillofacial surgery. As with all traumas, basic Advanced Trauma Life Support principles (ATLS) should be applied to the initial assessment of the casualty. The primary survey is given by the letters ABCDE.
• Airway maintenance with cervical spine protection.
• Breathing and ventilation.
• Circulation with hemorrhage control.
• Disability: neurological status.
• Exposure/environmental control - undress the patient but prevent hypothermia.
Each was explored and discussed.
Planning is making current decisions in the light of their future effects.
Health planning is a process culminating in decisions regarding the future provisions of health facilities and services to meet health needs of the community.
a very short and concise head and neck anatomy presentation; an overview of head and neck anatomy prepared for a mixed audience from different backgrounds
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
10. Anatomy and Physiology
of the Head
CNS Circulation
– Arterial
Four Major Arteries
2 Internal Carotid Arteries
2 Vertebral Arteries
Circle of Willis
Encircle the base of the brain
– Venous
Drain into internal jugular veins
13. Anatomy and Physiology
Blood-Brain Barrier
– Less permeable than elsewhere in body
– Does not allow flow of interstitial proteins
– Reduced lymphatic flow
– Very protected environment
16. CPP
Cerebral Perfusion Pressure
– Pressure within cranium (ICP) resists blood flow
and good perfusion to the CNS
Pressure usually less than 10 mmHg
– Mean Arterial Pressure (MAP)
Must be at least 50 mmHg to ensure adequate perfusion
MAP = DBP + 1/3 Pulse Pressure
– Cerebral Perfusion Pressure (CPP)
Pressure moving blood through the cranium
CPP = MAP - ICP
18. Anatomy and Physiology
The Monroe-Kelly Doctrine
– The ICP is dynamic
Constantly changing to variations in body physiology
– Intracranial Volume (fixed) = Brain Volume + CSF
Volume + Blood Volume + Mass/Lesion Volume
– Any added extrinsic factor that occupies space in
the cranial vault increases intracranial volume and
pressure
19. Anatomy and Physiology
Monroe-Kelly Doctrine
– Autoregulation
Changes in ICP result in compensation
Increased ICP = Increased BP
This causes ICP to rise higher and BP to rise
Brain injury and death become imminent
– Expanding mass inside cranial vault
Displaces CSF
If pressure increases, brain tissue is displaced
21. Face musclesM
Chewing musclesM
Posterior palate and pharynxM
Face musclesM
SightSOpticII
Pupil Const, rectus and obliquesMOculomotorIII
Opthalmic (FH), Maxillary (cheek), Mandible (chin)S
TrigeminalV
Lateral rectus muscleMAbducensVI
Taste to posterior tongueS
VagusX
TongueMHypoglossalXII
Trapezius and sternocleido musclesMAccessoryXI
Hearing balanceSAcousticVIII
Superior obliquesMTrochlearIV
TongueS
FacialVII
Posterior pharynx, taste to anterior tongueSGlossopharyn-
geal
IX
SmellSOlfactoryI
InnervationFNameCN
Cranial Nerves
Anatomy and Physiology
of the Head
22. Anatomy and Physiology
Ascending Reticular Activation System
– Tract of neurons in upper brainstem, pons, and midbrain
– Responsible for sleep-wake cycle
– Monitors input stimulation
– Regulates body functions
Respiration
Heart rate
Peripheral vascular resistance
24. Anatomy Physiology
Facial Structure
– Covered with skin
Flexible and thin
Highly vascular
– Minimal layer of subcutaneous tissue
Circulation
– External carotid artery
Supplies facial area
Branches
Facial, temporal, and maxillary arteries
25. Anatomy and Physiology
Nasal Cavity
– Upper Border
Bones
Junction of ethmoid, nasal, and maxillary bones
Bony Septum
Right and left chamber
Turbinates
– Lower Border
Bony hard palate
Soft palate
Moves upward during swallowing
– Nasal Cartilage
Forms nares
26. Anatomy and Physiology
Oral Cavity
– Formed Structures
Maxillary bone
Palate
Upper teeth meeting the mandible and lower teeth
– Floor
Tongue
– Mandible
Articulates with the TMJ joint
27. Anatomy and Physiology
Special Structures
– Salivary Glands
First stage in digestion
Location
Anterior and inferior to the ear
Under tongue
Inside the inferior mandible
– Tonsils
Posterior wall of the pharynx
28. Anatomy and Physiology
Sinuses
– Hollow spaces in cranium and facial bones
– Function
Lighten head
Protect eyes and nasal cavity
Produce resonant tones of voice
Strengthen area against trauma
29. Anatomy and Physiology
Pharynx
– Posterior and inferior to the oral cavity
– Aids in swallowing
Bolus of food propelled back and down by tongue
Epiglottis moves downward
Larynx moves up
Combined effect seals airway
Peristaltic wave moves food down esophagus
30. Anatomy and Physiology
Ear
– Function
Hearing
Positional sense
– Structures
Pinna
Outer visible portion
Formed of cartilage and has poor blood supply
External Auditory Canal
Glands that secrete cerumen (wax)
Middle and Inner Ear
Structures for hearing and positional sense
31. Anatomy and Physiology
Structures for
Hearing
Structures for
Proprioception
– Semicircular
canals
Sense position
and motion
– Present when
eyes are closed
– Vertigo
Continuous
movement
sensation
34. Anatomy and Physiology
Vasculature of the Neck
– Carotid Arteries
Arise from
Brachiocephalic artery
Aorta
Split
Carotid bodies and sinuses
Bodies: Monitor CO2 and O2 levels
Sinuses: Monitor blood pressure
35. Anatomy and Physiology
Jugular Veins
– External
Superficial, lateral to the trachea
– Internal
Sheath with the carotid artery and vagus nerve
36. Anatomy and Physiology
Airway Structures
– Larynx
Epiglottis
Thyroid and cricoid cartilage
– Trachea
Posterior border is anterior border of esophagus
38. Anatomy and Physiology
Other Structures of the Neck
– Esophagus
– Cranial Nerves
CN-IX (Glossopharyngeal)
Carotid bodies and carotid sinuses
CN-X
Speech, swallowing, cardiac, respiratory, and visceral function
– Thoracic Duct
Delivers lymph to the venous system
39. Anatomy and Physiology
Other Structures of the Neck
– Glands
Thyroid
Rate of cellular metabolism
Systemic levels of calcium
– Brachial Plexus
Network of nerves in lower neck and shoulder that
control arm and hand function
41. Pathophysiology of Head,
Facial, and Neck Injury
Difficult to assess in the prehospital setting
Commonly threaten life
May expose victims to lifelong disability
42. Mechanism of Injury
Injuries to the head, neck, and face are
divided by mechanisms of injury
– Blunt Injury
Head injuries most frequently result from auto and
motorcycle crashes
The face is frequently subjected to blunt trauma
The neck is anatomically well protected from most blunt
trauma
– Penetrating Injury
Usually result from either gunshots or stabbings
Other types of penetrating injuries
43. Head Injury
Defined as a traumatic insult to the cranial region
– Result in injury to soft tissues, bony structures, and the
brain
49. Brain Injury
“A traumatic insult to the brain capable of
producing physical, intellectual, emotional,
social, and vocational changes.”
National Head Injury Foundation
Classification
– Direct
– Indirect
50. Direct Brain Injury
Caused by the
forces of trauma
and can be
associated with a
variety of
mechanisms
Coup
Contrecoup
51.
52. Direct Brain Injury Categories
Focal
– Occur at a specific location in brain
Cerebral contusion
Intracranial hemorrhage
Epidural hematoma
Subdural hematoma
Intracerebral hemorrhage
Diffuse
– Concussion
– Moderate diffuse axonal injury
– Severe diffuse axonal injury
53. Focal Brain Injury
Cerebral Contusion
– Capillary bleeding into brain tissue
– Common with blunt head trauma
– May result from a coup or contrecoup mechanism
– Localized form of the injury manifests with
dysfunctions related to the site of the injury
54.
55.
56. Focal Brain Injury
Intracranial Hemorrhage
– Epidural Hematoma
Bleeding between dura
mater and skull
Involves arteries
Middle meningeal artery most
common
Rapid bleeding and
reduction of oxygen to
tissues
Herniates brain toward
foramen magnum
Progression is both rapid
and life threatening
57.
58.
59.
60. Focal Brain Injury
Intracranial Hemorrhage
(cont.)
– Subdural Hematoma
Bleeding between
meninges
Slow bleeding
Superior sagittal sinus
frequently injured
Signs progress over
several days
Slow deterioration of
mentation
61.
62.
63. Focal Brain Injury
Intracranial Hemorrhage (cont.)
– Intracerebral Hemorrhage
Ruptured blood vessel within the brain
Presentation similar to stroke symptoms
Signs and symptoms worsen over time
– Cerebral edema
Inflammatory response allows fluid leakage
– Hydrocephalus
May occur with hemorrhage into the subarachnoid space
67. Diffuse Brain Injury
Due to stretching forces placed on axons
Pathology distributed throughout brain
– Frequently distributed throughout the brain and
thus is called diffuse axonal injury (DAI)
Types
– Concussion
– Moderate diffuse axonal injury
– Severe diffuse axonal injury
68.
69. Diffuse Brain Injury
Concussion
– Mild to moderate form of diffuse axonal injury
– Nerve dysfunction without anatomic damage
– Transient episode of
Confusion, disorientation, event amnesia
– Suspect if patient has a momentary loss of
consciousness
– Management
Frequent reassessment of mentation
ABCs
70.
71. Diffuse Brain Injury
Moderate Diffuse Axonal Injury
– Stretching and tearing of neurons with minute
bruising of brain tissue
– Unconsciousness
If cerebral cortex and RAS involved
– Commonly associated with basilar skull fracture
– Signs and Symptoms
Unconsciousness, persistent confusion, inability to
concentrate, disorientation, and retrograde and
anterograde amnesia
72.
73. Diffuse Brain Injury
Severe Diffuse Axonal Injury
– Significant mechanical disruption of axons
Cerebral hemispheres and brainstem
– High mortality rate
– Signs and Symptoms
Prolonged unconsciousness
Cushing’s reflex
Decorticate or decerebrate posturing
74. Indirect Brain Injury
Indirect (or secondary) injuries are the result
of factors that occur because of, though after,
the initial (or primary) injury
Caused by two distinct pathological
processes
– Diminishing circulation to brain tissue due to an
increasing ICP
– Progressive pressure against, or physical
displacement of, brain tissue
75. Intracranial Perfusion
Review
– Cranial volume fixed
80% = Cerebrum, cerebellum, and brainstem
12% = Blood vessels and blood
8% = CSF
– Increase in size of one component diminishes
size of another
Inability to adjust = increased ICP
76. Intracranial Perfusion
Compensating for Pressure
– Compress venous blood vessels
– Reduction in free CSF
Pushed into spinal cord
Decompensating for Pressure
– Increase in ICP
– Rise in systemic BP to perfuse brain
Further increase of ICP
Dangerous cycle
77. Intracranial Perfusion
Role of Carbon Dioxide
– Increase of CO2 in CSF
Cerebral vasodilation
– Contributes to > ICP
– Causes classic symptom
Hyperventilation and hypertension
– Reduced levels of CO2 in CSF
Cerebral vasoconstriction
Results in cerebral anoxia
78. Factors Affecting ICP
Vasculature Constriction
Cerebral Edema
Systolic Blood Pressure
– Low BP = Poor cerebral
perfusion
– High BP = Increased ICP
Carbon Dioxide
Reduced respiratory
efficiency
82. Signs and Symptoms
of Brain Injury
Altered Mental Status
– Altered orientation
– Alteration in personality
– Amnesia
Retrograde
Antegrade
Cushing’s Reflex
– Increased BP
– Bradycardia
– Erratic respirations
Vomiting
– Without nausea
– Projectile
Body temperature
changes
Changes in pupil
reactivity
Decorticate posturing
83. Signs and Symptoms
of Brain Injury
Physiological Changes
– Frontal Lobe Injury
Alterations in personality
– Occipital Lobe Injury
Visual disturbances
– Cortical Disruption
Reduced mental status or amnesia
Retrograde
Unable to recall events before injury
Antegrade
Unable to recall events after trauma
“Repetitive questioning”
– Focal Deficits
Hemiplegia, weakness, or seizures
84. Central Syndrome
Progressive pressure and structural
displacement are somewhat predictable
– Known as Central Syndrome
Physiological Changes
– Upper Brainstem Compression
Increasing blood pressure
Reflex bradycardia
Vagus nerve stimulation
Cheyne-Stokes respirations
Pupils become small and reactive
Decorticate posturing
86. Central Syndrome
Physiological Changes (cont.)
– Lower Brainstem Injury
Pupils dilated and unreactive
Ataxic respirations
Erratic with no pattern
Irregular and erratic pulse rate
ECG changes
Hypotension
Loss of response to painful stimuli
87. Recognition of Herniation
Cushing’s Reflex
– Increasing blood pressure
– Decreasing pulse rate
– Respirations that become erratic
Lowering level of consciousness
– GCS <9 and dropping
Singular or bilaterally dilated and fixed pupils
Decerebrate or decorticate posturing
No movement with noxious stimuli
88. Pediatric Head Trauma
Different pathology than older patients
– Skull can distort due to anterior and posterior
fontanelles
Bulging
Slows progression of increasing ICP
– Intracranial hemorrhage contributes to
hypovolemia
Decreased blood volume in pediatrics
General Management
– Avoid hyperextension of head
Tongue pushes soft palate closed
– Ventilate through mouth and nose
90. Eye Signs
Physiological Issues
– Indicate pressure on
CN-II, CN-III, CN-IV, and CN-VI
– Reduced peripheral blood flow
Pupil Size and Reactivity
– Reduced pupillary responsiveness
Depressant drugs or cerebral hypoxia
– Fixed and dilated
Extreme hypoxia
91. Facial Injury
Facial Soft-Tissue Injury
– Highly vascular tissue
Contributes to hypovolemia
– Superficial injuries are rarely life threatening
– Deep injuries can result in blood being
swallowed and endanger the airway
– Soft tissue swelling reduces airflow
– Consider likelihood of basilar skull fracture or
spinal injury
93. Facial Injury
Nasal Injury
– Rarely life threatening
– Swelling and hemorrhage interfere with breathing
– Epistaxis
Most common problem
– Avoid nasotracheal intubation
Passage of ET tube into the cerebral cavity
94. Facial Injury
Ear Injury
– External Ear
Pinna frequently injured due to trauma
Poor blood supply
Poor healing
– Internal Ear
Well protected from trauma
May be injured due to rapid pressure changes
95. Facial Injury
Eye Injury
– Foreign bodies
– Corneal abrasions
and lacerations
– Hyphema
Blunt trauma to the
anterior chamber of the
eye
– Sub-conjunctival
hemorrhage
Less serious condition
May occur after strong
sneeze, severe vomiting,
or direct trauma
96. Eye Injury (cont.)
– Acute Retinal Artery Occlusion
Non-traumatic origin
Painless loss of vision in one eye
Occlusion of retinal artery
– Retinal Detachment
Traumatic origin
Complaint of dark curtain/obstruction in the field of view
Possibly painful depending on type of trauma
– Soft-Tissue Lacerations
Facial Injury
97. Neck Injury
Blood Vessel Trauma
– Blunt trauma
Serious hematoma
– Laceration
Serious exsanguination
Entraining of air embolism
Cover with occlusive dressing
Airway Trauma
– Tracheal rupture or dissection from larynx
– Airway swelling and compromise
98. Neck Injury
Cervical Spine Trauma
– Vertebral fracture
Paresthesia, anaesthesia, paresis, or paralysis beneath
the level of the injury
Neurogenic shock may occur
Subcutaneous emphysema
– Tension pneumothorax
– Traumatic asphyxia
99. Neck Injury
Penetrating trauma
– Esophagus or trachea
– Vagus nerve disruption
Tachycardia and GI disturbances
– Thyroid and parathyroid glands
High vascular
101. Assessment of Head,
Facial, and Neck Injuries
Assessment follows the standard format
– Size-up
– Initial assessment
– Rapid trauma assessment/focused exam and
history
– Detailed assessment
Pay special attention to ensuring airway
patency
Consider the need for rapid transport
102. Scene Size-Up
Consider the circumstances of injury
Identify the nature and extent of forces that
caused the injury
– Spider-web windshield, deformity of the upper
steering wheel, helmet use in motorcycle
Rule out scene hazards
103. Initial Assessment
Form an initial impression
– Be alert to the patient’s facial skin color,
respiratory effort, and to pupil luster and level of
responsiveness throughout the initial assessment
Apply a cervical collar at the end of the initial
assessment
104. Initial Assessment
Airway
– Examine the face and neck for any deformity,
swelling, hemorrhage, foreign bodies, or other
signs of injury
– Listen for unusual or changing voice patterns
– Anticipate vomiting
– Suctioning or intubation may worsen ICP
105. Initial Assessment
Breathing
– Ensure that the patient is moving an adequate
volume of air
– Head injury is likely to produce irregular breathing
patterns
– Ventilations for the serious head injury patient
(GCS ≤8) are guided by capnography
Maintain an end-tidal CO2 reading of between 35 and 40
mmHg
For patients with suspected herniation, the end-tidal CO2
reading should range between 30 and 35 mmHg
– Apply oxygen via nonrebreather mask to the
breathing patient
106. Initial Assessment
Circulation
– Monitor the patient’s pulse rate and rhythm
– Look for any hemorrhage from the head, face, and
neck and control any moderate to severe bleeding
– Maintain a blood pressure of at least 90 mmHg
107. Rapid Trauma Assessment
A quick and directed head-to-toe examination
of a patient
Manage any life-threatening injuries and
conditions as you find them during the rapid
trauma assessment
– If the patient shows any signs of pathology within
the cranium, consider rapid transport
109. Head, Facial, and Neck
Injury Management
Management priorities for the patient
sustaining head, face, or neck trauma
include:
– Maintaining the patient’s airway and breathing
– Ensuring circulation through hemorrhage control
– Taking steps to avoid hypoxia and/or hypovolemia
– Providing appropriate medications
110. Head, Facial, and Neck
Injury Management
Airway
– Patients may be unable to control the airway
Altered level of consciousness
Damaged airway structures
– Sellick’s manuever
– Suctioning
May increase ICP
Emesis is common with head injury
111. Head, Facial, and Neck
Injury Management
Airway (cont.)
– Patient positioning
Initial left-lateral recumbancy with cervical precautions, if
possible
Approximately 30° elevation of head of spine board
– Basic airway adjuncts
Oro and nasopharyngeal airways
Be prepared for emesis
113. Head, Facial, and Neck
Injury Management
Airway (cont.)
– Cricothyrotomy
Needle
cricothyrostomy and
the open
cricothyrotomy
114. Head, Facial, and Neck
Injury Management
Breathing
– Oxygenation
Any indication of lowered level of consciousness,
orientation, or arousal is a candidate for high-flow, high-
concentration oxygen
– Ventilation
Avoid hyperventilation
Decreased CO2 results in vasoconstriction
Maintain an end-tidal CO2 reading of between 35 and 40 mmHg
115. Head, Facial, and Neck
Injury Management
Circulation
– Control hemorrhage
An open neck injury carries the risk of air entering the
external jugular
– Blood pressure maintenance
Guard against hypotension
Maintain systolic BP at 90 mmHg
117. Medications
Diuretics
– Mannitol
Osmotic diuretic
Draws water from the interstitial space and into the
cardiovascular system
– Use may reduce ICP
– Contraindications
Renal failure
Hypotension
– Slow IV bolus of 0.25 to 1 g/kg over 10 to 20
minutes
118. Medications
Paralytics
– Drugs that paralyze the skeletal muscles,
permitting intubation in patients with whom the
procedure would otherwise be impossible
Rapid Sequence Intubation
Uses etomidate, diazepam, midazolam, fentanyl, or morphine
sulfate to sedate the patient
Succinylcholine chloride, atracurium, or vercuronium to paralyze
the patient
119. Medications
Dextrose
– Hypoglycemia and hyperglycemia are detrimental
to the patient with head injury
Identify the blood glucose level on all unresponsive
patients
– If significant hypoglycemia is found, administer 25
mg of glucose and 100 mg of thiamine
120. Medications
Thiamine
– Substance obtained from diet and needed for
body metabolism
– In malnourished patients (like the chronic
alcoholic), thiamine is depleted
Glucose cannot be converted
Brain is very sensitive to lack of Glucose
121. Medications
Topical Anesthetic Spray
– Reduces the gag reflex, making endotracheal
intubation easier
Reduces the impact retching has on intracranial
pressure
– Effects of the agent are immediate (within 15
seconds), remain local, and last for about 15
minutes
123. Emotional Support
Have friend or family provide constant
reassurance
Provide constant reorientation to environment
if required
– Keeps patient calm
– Reduces anxiety
124. Special Injury Care
Scalp Avulsion
– Cover the open wound with bulky dressing
– Pad under the fold of the scalp
– Irrigate with NS to remove gross contamination
125.
126. Special Injury Care
Eye Injury
– General Injury
Cover injured and uninjured eye
Prevents sympathetic motion
Consider sterile dressing soaked in NS
– Corneal Abrasion
Invert eyelid and examine eye for foreign body
Remove with NS-moistened gauze or Morgan’s lens
– Avulsed or Impaled Eye
Cover and protect from injury
– General Care
Calm and reassure patient
127.
128. Special Injury Care
Dislodged Teeth
– Rinse in NS
– Wrap in NS-soaked gauze
Impaled Objects
– Secure with bulky dressing
– Stabilize object to prevent movement
– Indirect pressure around wound
