Clinical Practice Guidelines for Traumatic Brain Injury 2556Utai Sukviwatsirikul
Clinical Practice Guidelines for Traumatic Brain Injury 2556
แนวทางเวชปฏิบัติกรณีสมองบาดเจ็บ (Clinical Practice Guidelines for Traumatic Brain Injury) พิมพ์ครั้งที่ 1 2556
http://pni.go.th/pnigoth/wp-content/uploads//2013/10/Clinical-Practice-Guidelines-for-Traumatic-Brain-Injury.pdf
Clinical Practice Guidelines for Traumatic Brain Injury 2556Utai Sukviwatsirikul
Clinical Practice Guidelines for Traumatic Brain Injury 2556
แนวทางเวชปฏิบัติกรณีสมองบาดเจ็บ (Clinical Practice Guidelines for Traumatic Brain Injury) พิมพ์ครั้งที่ 1 2556
http://pni.go.th/pnigoth/wp-content/uploads//2013/10/Clinical-Practice-Guidelines-for-Traumatic-Brain-Injury.pdf
This document discusses head injuries and their management. It covers various types of head injuries like scalp lacerations, skull fractures, and different types of intracranial bleeding. Assessment involves the Glasgow Coma Scale and other scales. Management depends on the type of injury and may include wound closure, observation, surgery to repair fractures or evacuate hematomas. The goal is to prevent secondary brain damage from low blood pressure, hypoxia, swelling, and infections.
The Glasgow Coma Scale (GCS) was developed as a simple, practical tool for assessing neurological injury and monitoring patients. It evaluates eye opening, verbal response, and motor response on a scale of 3-15. A lower score indicates a lower level of consciousness and worse prognosis. While initially created for adults, modified versions have been made for children who cannot communicate verbally. Though developed decades ago, the GCS remains the standard for initial assessment of brain injury severity and predicting outcomes.
This document discusses head injuries and their management. It covers various types of head injuries like scalp lacerations, skull fractures, and different types of intracranial bleeding. Assessment involves the Glasgow Coma Scale and other scales. Management depends on the type of injury and may include wound closure, observation, surgery to repair fractures or evacuate hematomas. The goal is to prevent secondary brain damage from low blood pressure, hypoxia, swelling, and infections.
The Glasgow Coma Scale (GCS) was developed as a simple, practical tool for assessing neurological injury and monitoring patients. It evaluates eye opening, verbal response, and motor response on a scale of 3-15. A lower score indicates a lower level of consciousness and worse prognosis. While initially created for adults, modified versions have been made for children who cannot communicate verbally. Though developed decades ago, the GCS remains the standard for initial assessment of brain injury severity and predicting outcomes.
Alteration of consciousness can result from diminished alertness due to widespread brain abnormalities or reduced activity of the reticular activating system. Confusion is characterized by impaired attention/concentration and disorientation, while delirium involves additional symptoms like agitation, hallucinations, and convulsions. Levels of consciousness range from alert to comatose. Confusion can be caused by medical/surgical diseases, infections, drugs, or nervous system disorders and is evaluated through history, exam focusing on attentiveness/orientation, and controlling underlying illnesses. The Glasgow Coma Scale assesses eye, motor, and verbal responses to determine coma depth.
Summary and illustrations of various traumatic brain injury including primary and secondary lesions as well as limited information on indications of brain imaging in trauma
This document discusses head injuries and concussions, including their nature, types, signs and symptoms, and management. Head injuries range from minor lacerations to skull fractures and brain bleeding/damage. Concussions are caused by trauma to the head and can cause temporary impairment. Signs of head injuries include headache, nausea, reduced consciousness, and visual/neurological issues. Management of head injuries follows DRABCD protocol (danger, response, airway, breathing, compressions, defibrillation) and involves stabilizing the victim, monitoring vitals, and seeking immediate medical help if needed.
TSSA 06 apparato neurologico e disturbi metaboliciEmergency Live
Il corso TSSA (corso nazionale per l’attività di trasporto sanitario e soccorso in ambulanza) è il corso sanitario avanzato della Croce Rossa Italiana che si prefigge di formare il SOCCORRITORE, cioè il Volontario che svolgerà la sua attività sulle ambulanza e perciò il percorso addestrativo è tipicamente sanitario. I corsi sono tenuti da Istruttori di Croce Rossa qualificati con un apposito percorso specifico.
In queste slide presentiamo la dispensa dedicata all'apparato neurologico e ai disturbi metabolici, con alterazioni dello stato di coscienza, con la valutazione della risposta neurologica
Head injuries top the list of trauma patienrts coming to the casualty. The condition has to be immediately assessed and investigated. Depending upon the findings prompt medical or neurosurgical treatment has to be administered.
Traumatic brain injury in small animals often results from vehicular trauma, crush injuries, falls, or attacks. The document discusses the pathophysiology of primary and secondary brain injury following trauma. It emphasizes the importance of stabilizing vital organs, maintaining adequate cerebral perfusion pressure, lowering intracranial pressure through fluids, mannitol, and respiratory management. Proper evaluation, monitoring, and supportive care are essential to optimize outcomes in small animal patients with head trauma.
Brain imaging is important in trauma to identify injuries from primary impact and secondary complications. CT is best for acute trauma to detect fractures and hemorrhages while MRI is more sensitive for diffuse injuries. Common primary injuries seen include fractures, contusions, hematomas, shearing injuries and hemorrhages in various locations. Secondary complications can include swelling, infection and herniations putting pressure on vessels.
This document discusses traumatic brain injury and maintaining adequate cerebral perfusion. It defines traumatic brain injury as direct brain damage from impact. Secondary injuries can worsen the primary injury during transport due to processes like expanding hematomas. Cerebral perfusion pressure must be maintained to provide the brain with adequate blood flow and oxygen. Signs of increased intracranial pressure like changes in level of consciousness can help assess the brain indirectly when intracranial pressure cannot be directly measured. Treatment focuses on decreasing intracranial pressure through interventions like medication, ventilation, and positioning to preserve brain function during transport.
Alteration of consciousness can result from diminished alertness due to widespread brain abnormalities or reduced activity of the reticular activating system. Confusion is characterized by impaired attention/concentration and disorientation, while delirium involves additional symptoms like agitation, hallucinations, and convulsions. Levels of consciousness range from alert to comatose. Confusion can be caused by medical/surgical diseases, infections, drugs, or nervous system disorders and is evaluated through history, exam focusing on attentiveness/orientation, and controlling underlying illnesses. The Glasgow Coma Scale assesses eye, motor, and verbal responses to determine coma depth.
Head injuries can range from minor to severe brain injury. They are a major cause of death and disability worldwide. A head injury occurs when trauma causes injury to the scalp, skull, or brain. Common causes include road traffic accidents and falls. Head injuries are classified based on severity from mild to severe using the Glasgow Coma Scale. Diagnosis involves history, examination, and imaging like CT scan. Management depends on the type and severity of injury but generally involves stabilizing the patient, treating any brain injury, and preventing complications like raised intracranial pressure.
This document provides information on the management of traumatic brain injury (TBI). It defines TBI as an alteration in brain function caused by a blow or jolt to the head. The primary survey for a TBI patient involves assessing the airway, breathing, circulation, disability or neurological status, and exposure. Disability is evaluated using the Glasgow Coma Scale. Mild TBI is defined as a brief alteration in mental status or consciousness with a Glasgow Coma Scale score between 13-15. The document also discusses complications, guidelines for CT scans, and classifications of mild versus severe TBI.
This document provides an overview of the brain and cranial nerves. It begins by introducing the topic and expected learning outcomes. It then describes the major anatomical landmarks of the brain including the cerebrum, cerebellum, and brainstem. It discusses the locations of gray and white matter in the brain. Finally, it covers the embryonic development of the central nervous system and how this relates to adult brain anatomy.
Presentation1.ppt on menengies finalisedfarhan_aq91
The document discusses three main topics:
1) The meninges of the brain including the three meningeal layers, the two intracranial spaces, and the four dural septa.
2) Intracranial hemorrhage.
3) The dural venous sinuses including the eight main sinuses and the contents and communications of the cavernous sinus.
1) Critical care for head injury patients involves managing increased intracranial pressure (ICP) to prevent herniation and death. Nursing management includes measures to decrease blood and cerebrospinal fluid volume like osmotic diuretics.
2) Monitoring a patient's Glasgow Coma Scale (GCS) and FOUR score can assess severity of injury from mild to severe. One point increase in FOUR score can reduce mortality by 36% and improve neurological outcomes.
3) Initial resuscitation of severe traumatic brain injury focuses on securing the airway, ensuring oxygenation and circulation to optimize cerebral perfusion pressure and prevent secondary insults like hypotension and hypoxia. Close monitoring of vital signs and neurological status is
The document discusses various trauma scoring systems used to assess injury severity and predict patient outcomes. It describes anatomical indices like the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) which evaluate individual injuries and overall trauma burden. It also outlines physiological scores such as the Trauma Score, Revised Trauma Score, and CRAMS scale that assess vital signs and neurological status. Combination scores like TRISS use both anatomical and physiological factors to determine survival probabilities for trauma patients. Early warning scores evaluate pre-hospital and emergency department patients to guide triage and care.
The document discusses various trauma scoring systems used to assess injury severity, predict survival chances, and guide triage and treatment of trauma patients. It describes anatomical indices like the Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) which evaluate individual injuries and overall injury burden. It also covers physiological scales like the Trauma Score, Revised Trauma Score, and CRAMS scale. Multiple organ dysfunction scores like SOFA are presented, along with mass casualty triage algorithms like START and SALT.
This document provides guidance on the management of multiple trauma patients. It outlines the ABCDE approach and trauma concept, which emphasizes rapidly assessing and treating the most life-threatening injuries first before making definitive diagnoses.
The primary survey involves simultaneously assessing the patient's airway, breathing, circulation, disability, and exposure. Adjuncts like monitoring, catheters and imaging may be used but not delayed transfer. The secondary survey obtains a more detailed history and physical exam.
Special considerations for pediatric, geriatric, and pregnant trauma patients are discussed. Key physiological differences and injury patterns are highlighted. The document also reviews complications like tension pneumothorax, cardiac tamponade and hemorrhagic shock and their
- Shocks occur when there is inadequate tissue perfusion and oxygenation due to problems like blood loss, fluid loss, tension pneumothorax, cardiac tamponade, etc.
- Clinical signs of shock include anxiety, tachycardia, tachypnea, decreased urine output, pale and cool skin.
- Treatment of shock involves rapid identification of the cause, stopping any ongoing bleeding, and fluid resuscitation. Blood transfusion may be needed for more severe cases. Care must be taken to avoid complications like hypothermia, acidosis, and coagulopathy during resuscitation.
This document discusses the approach to head-injured patients. It begins by outlining the primary and secondary surveys, which involve assessing the ABCDEs, immobilizing the patient, performing a brief neurological exam, inspecting, palpating and examining the head and cervical spine, determining the Glasgow Coma Scale, documenting findings, and reassessing over time. It then notes that the elderly over 65 are more susceptible to bleeding from head injuries due to brain shrinkage creating fragile bridging veins.
5. Traumatic shock Assessment
Assess : ABC
HR, V/S, LOC, Capillary refill time, O2 sat
Evaluate mechanism of injury and other injuries
Signs of Shock
Hypoperfusion
External bleeding
Sign of hypovolemia
Hypovolemic Shock
หายใจลาบาก หัวใจเต้นเร็ว เสียง
หายใจลดลง ใช้กล้ามเนื้อช่วยใน
การหายใจ
Trachea deviation,
Unilateral chest movement
Paradoxical movement
Cardiogenic /
Obstructive Shock
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แขน ขา อ่อนแรง
เคลือนไหวแขน ขาไม่ได้
่
Spinal Shock
6. ผู้ป่วยบอกชื่อ นามสกุลได้ถกต้อง จาไม่ได้วาเกิดเหตุ
ู
่
อะไร มีแผลฉีกขาด ที่หน้าผากและขมับด้านขวา เข่า
ซ้ายบวมมาก (ไม่ได้กลินแอลกอฮอล์จากลมหายใจ)
่
P 110 BP 135/84 RR 18 O2sat 100%
จะจัดการให้การดูแลผูปวยอย่างไร
้ ่
1. รับตัวผูปวยไว้สงเกตอาการ
้ ่
ั
2. เตรียมส่งตรวจ Head CT scan
3. ให้ O2 mask with reservoir bag 10 LPM
4. ห้ามเลือด ปิดแผล เตรียมเปิดเส้นให้ สารน้า
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7. ATLS : Advance Trauma Life Support
1 survey and resuscitation
2 survey and management
Airway Maintenance
with Cervical Spine
Protection
Breathing: ventilation
and oxygenation
Circulation with
hemorrhage control
Disability: Brief
neurologic examination
Exposure/
Environmental control
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Head to toe
examination
History:
MIVT
(mechanism of
injury, injury
sustained, V/S,
treatment)
AMPLE
9. Trauma Brain Injury
Airway management and C-spine protection
Assess : LOC, GCS, pupils, V/S, mechanism of injury
Mild TBI
(GCS = 13-15)
Moderate TBI
(GCS = 9-12)
Oxygen mask with reservoir
bag 10 LPM
Monitor : V/S, N/S, O2 sat,
LOC, GCS
Prepare for : x-ray, surgical
treatment
Medication : headache,
nausea & vomiting
Inform caregiver
Nursing record
Oxygen mask with reservoir
bag 10-12 LPM
Prepare for : definite airway
IV fluid
Monitor : V/S, N/S, O2 sat,
LOC, GCS
Prepare adjuncts : N-G tube,
Foley catheter, ECG, Cut
down
Prepare for : x-ray, CT,
diagnostic tests, surgical
treatment
Inform caregiver
Nursing record
Definite care
Re-assess
Severe TBI
(GCS = 3-8)
Hold mask with bag 10-12
LPM
Assisted in endotracheal
tube
IV fluid
Monitor : V/S, N/S, O2 sat,
LOC,GCS
Prepare adjuncts : Foley
catheter, N-G tube, ECG,
Cut down
Prepare for : x-ray, CT,
surgical treatment,
diagnostic tests
Inform caregiver
Nursing record
10. การจัดการบาดเจ็บที่ศีรษะ
Airway clearance
Adequate gas exchange
Adequate tissue perfusion
Free from injury
Clear bilateral breath sounds
Regular rate, depth, and pattern of breathing
O2sat 95%, GCS 14-15, V/S normal
Normal pupil size, shape, and reactivity to light
Absence of signs of injury
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11. The need of Head CT scan
Canadian Head CT rules
• High risk
New Orleans criteria
• GCS < 15 ; 2 hours after
• Headache
• injury
• Vomiting
• Open/depressed skull
• Age > 60 years
fracture
• Drug/alcohol intoxication
• > 2 episodes of vomiting
• Seizure
• basilar skull fracture
• Evidence of trauma
• Age > 65 years
above the clavicles
• Medium risk
• Amnesia > 30 min prior to
injury high mechanism
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16. Diffuse Axonal Injury
Loss of consciousness at the time of injury that
continues beyond 6 hours
Damage to conducting white matter
Disconnects the cerebral hemispheres from
the brainstem
23. Secondary injury
Primary injury
• Directly by the
external force
• Injury evident
on P/E and CT
scan
• Occurs in the hours
to days following the
primary injury
• Cellular damage;
• Lack of oxygen
delivery
• Increased ICP
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29. Severity of injuries
Mild
Moderate
Severe
head injury
head injury
head injury
• GCS = 13-15
• GCS = 9-12
• associated with
• associated with
• GCS less than
or equal to 8
loss of
a loss of
consciousness
consciousness
loss of
or amnesia for
for up to a day
consciousness
less
• associated with
for more than
24 hours
• than 1 hour
ผศ.ดร.กรองได อุณหสูต
30. Indications for Hospital Admission
• Deteriorating GCS
• Abnormalities on imaging
• GCS <15 after imaging
• Focal or abnormal neurological signs
• Early post-traumatic seizure
• Mild head injuries with symptoms; headache,
photophobia, nausea and vomiting, amnesia
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33. Information
to accompany the patient
Demographic information
Injury events
Pre-hospital care
Summary of evaluation & care
Referring doctor
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34. Assessment & interventions
in the safe transfer
Ineffective airway clearance
Ineffective breathing patterns
Gas exchange
Decrease cardiac output
Altered cerebral tissue perfusion
High risk for injury
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