Here are two slideshows, head trauma, which gives a quick guide to ER team, how to prepare and manage a case with a 1st response, Then - a guideline for Tetanus prophylaxis and management, for suspected cases as hundreds of cases still are found annually. Spread the knowledge!

1. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
ER-HEAD TRAUMA
(SKULL AND BRAIN)
TETANUS MANAGEMENT
14 - September - 2012
Prepared By Dr Gamal Soliman
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2. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
HEAD TRAUMA-DEFINITION
Head injury can result from direct or indirect impact that causes the
brain to move forward, rebound backward, or rotate against the
rigid, irregular surface of the skull. Most frequently seen in motor
vehicle accidents, head trauma is also a common finding following
falls, seizures intoxication, and physical assault.
14 - September - 2012
Prepared By Dr Gamal Soliman
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3. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
OBJECTIVE
1. To provide immediate
care to the patient
2. To prevent further
trauma
3. To prevent
complications
14 - September - 2012
Prepared By Dr Gamal Soliman
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4. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
POLICY
1. Brain injury is classified as:
1.1 Concussion – maybe so mild that the patient is unaware of
the injury, the patient may complain of headache, dizziness or
nausea.
Contusion – can occur with closed head injury when the
forced of the blow is great enough to rupture blood vessels
found in the surface of or deep within the brain.
Direct – can occur in open head injury with brain being
lacerated, punctured or bruised by broken bones of the skull.
14 - September - 2012
Prepared By Dr Gamal Soliman
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5. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
2. Skull injuries are classified as:
2.1 Skull fractures
2.1.1 Linear skull fracture, thin
line crack in the cranium
2.1.2 Comminuted skull
fracture
2.1.3 Depressed skull fracture bone
fragments
2.1.4 Basal skull fracture.
2.2 Facial fractures- usually produced by
an impact.
14 - September - 2012
Prepared By Dr Gamal Soliman
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6. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3. Patients with head injuries require immediate assessment
for prompt and rapid treatment and management.
4. Stabilization of airway is the first priority for patients with
head injury.
14 - September - 2012
Prepared By Dr Gamal Soliman
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7. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5. For cervical spinal injury, head and neck
immobilization had to be maintained.
6. Head trauma patients are assessed for the
presence of
6.1 Ineffective airway clearance from secretions and
vomitus.
6.2 Ineffective breathing pattern.
6.3 Alteration in sensory perception and though
process due to injury.:
14 - September - 2012
Prepared By Dr Gamal Soliman
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8. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
7. Oxygen is administered immediately and vital signs are obtained
and monitored including neurological assessment. (Glasgow Coma
Scale).
8. Fluid administration is initiated and intake and output is
measured to prevent excess fluid administration.
9. Bleeding is controlled and medications started as ordered.
10. Blood is obtained for baseline laboratory analysis, and x-rays for
any signs or cervical trauma.
14 - September - 2012
Prepared By Dr Gamal Soliman
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9. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
MATERIALS & EQUIPMENT
1. Oxygen- cannula /mask
2. Gauze dressing/ pressure
dressing pads
3. Suction machine
4. IV fluids and medications
as prescribed
14 - September - 2012
Prepared By Dr Gamal Soliman
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10. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
PROCEDURE RATIONALE
1. Monitor and assess neurologic and
vital signs frequently as ordered. 1. For
prevention, early recognition,
and prompt treatment
14 - September - 2012
Prepared By Dr Gamal Soliman
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11. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
complications.
2. Stabilize the airway: 2. Inability to
effectively clear the
airway may results in anoxia,
hypercapnea, and aspiration.
3. Place the patient in a safe and
comfortable position. 3. To protect from
injury.
4. Talk to the patient, if conscious 4. Helps
detects changes in level of
consciousness.
14 - September - 2012
Prepared By Dr Gamal Soliman
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12. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5. Provide IV access for:
5.1 IV fluid administration
5.2 IV medications
5.3 Blood samples
14 - September - 2012
Prepared By Dr Gamal Soliman
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13. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
6. Administer Oxygen, obtains ABG
6. To prevent hypoxia and assess
for respiratory compromise.
7. Control bleeding by:
7.1 Do not apply pressure if the
injury sites shows bone
fragment or depression of
bone or if brain is exposed.
7.2 Do not attempt to stop the flow
of blood or CSF from the ears
or nose.
14 - September - 2012
Prepared By Dr Gamal Soliman
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14. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
PROCEDURE RATIONALE
1.4
14 - September - 2012
1.2 Breathing
1.3 Circulation
Vital signs should receive high flow,
humidified oxygen (100%).
Prepared By Dr Gamal Soliman
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15. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
TETANUS
14 - September - 2012
Prepared By Dr Gamal Soliman
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16. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
DEFINITION
Tetanus is a clinical syndrome caused by the release of a
potent neurotoxin produced by clostridium tetani.
14 - September - 2012
Prepared By Dr Gamal Soliman
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17. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
OBJECTIVE
1. To prevent hypoxia.
2. To prevent and
treat convulsions.
3. To protect the
patient from injury.
14 - September - 2012
Prepared By Dr Gamal Soliman
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18. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
POLICY
1. Assessment of patient includes:
1.1 Lockjaw (stiffness of the jaw).
1.2 Convulsions, twitching
1.3 Difficulty of swallowing.
1.4 Excessive yawning
1.5 Muscle spasms
1.5 Opisthotonus (extreme arching of the back
and retraction of the head
14 - September - 2012
Prepared By Dr Gamal Soliman
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19. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3. The patient shoule be placed in a quiet and dark room
a possible to avoid triggering spasms.
4. Airway and breathing pattern are maintained.
14 - September - 2012
Prepared By Dr Gamal Soliman
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20. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5. Oxygen administration and endotracheal intubation
6. Positioned properly to facilitate drainage of oral secretions.
7. Tetanus immunization immediately,
8. All patients with generalized tetanus need immediate critical
care.
9. Vital signs are taken and recorded frequently.
14 - September - 2012
Prepared By Dr Gamal Soliman
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21. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
PROCEDURE RATIONALE
1. Assess patient for:
1.1 Stiffness of the jaw
1.2 Convulsions, twitching
1.3 Difficulty of swallowing
1.4 Excessive yawning
1.5 Muscle spasm
14 - September - 2012
Prepared By Dr Gamal Soliman
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22. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
Provide intravenoud
access
6.1 I.V. fluids
6.2 Medications –
anti-convulsants
6.2 To treat
convulsions.
14 - September - 2012
Prepared By Dr Gamal Soliman
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23. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
PROCEDURE RATIONALE
7. Raise up side rails and
stay with the
patient. 7. To protect
from injury.
8. Administer tetanus
vaccine. 8. For tetanus
8.4 Tetanus immunoglobulin
8.5 dTT (diptheria – tetanus
toxoid)
9. Encourage the patient to
complete
his immunization.
14 - September - 2012
Prepared By Dr Gamal Soliman
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24. S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
10. Monitor vital signs frequently
and
report any abnormality. 10.
The patient initially have
a low-grade fever.
11. Expedite admission, if
required.
14 - September - 2012
Prepared By Dr Gamal Soliman
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