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M6 13-005

Exam 15: Head Injuries

Craniocerebral Trauma Include an alternation in consciousness. Second most common cause of neurological injury. Head trauma is used to signify craniocerebral trauma or head injury which includes an alteration of consciousness, no matter how brief.
Craniocerebral Trauma (Fun Facts) Major cause of death between ages 1 and 35. TBI incidence twice as high in males than females. The amount of obvious damage may not reflect the extent of injury. Effects of injury can lead to cerebral edema, IICP and sensory and/or motor deficits.
Craniocerebral Trauma (Causes) MVA’s Falls Recreational injuries Sports trauma Assaults Craniocerebral Trauma
Craniocerebral Trauma Results in injury to Scalp Skull Brain tissue Injuries vary Scalp lacerations Open fractures Severe brain damage
Injuries to the brain can result from direct or indirect trauma
Indirect trauma the tension strain and shearing forces transmitted by the stretching of the neck.
Direct trauma when the head is directly injured. This results in an acceleration-deceleration injury with rotation of the skull and its contents. Bruising of the occipital and frontal lobes as well as the brain stem and cerebellum may occur.
Craniocerebral Trauma Effects include Cerebral edema Sensory deficits Motor deficits Increased intracranial pressure Open Head Injuries Linear Comminuted Depressed Compound fractures
Linear Fracture incomplete break, typical line
Depressed Fracture Results from a blunt trauma to a flat bone- causing an indentation
Comminuted Fracture Bone is shattered into two or more fragments or pieces
Compound fracture an open wound exists over the fracture site, often bone may be protruding through the skin
Closed Head Injuries Laceration Concussion Contusion
Laceration Bleed profusely Is not always relevant to the significance of the injury.
lacerations of the scalp bleed profusely because large vascularity in the region. Heavy bleeding is not always reflective of significant injury.
Concussion results from violent jarring of the brain against the skull. Patient can experience brief loss of consciousness followed by confusion, headache, irritability, dizzy spells, unsteady gait.
Contusion Damage to brain tissue and nerve fibers Bruising and possible hemorrhage Bruising at site of injury or on opposite side Permanent damage may result
Contusion is more severe than a concussion due to possible hematoma, bruising and possible hemorrhage of superficial cerebral tissue. Bruising of the brain occurs at site of injury or on the opposite side. Permanent damage may result
Contusion results from a serious blow to the head associated with damage to brain tissue and nerve fibers
Hematoma Results from hemorrhage post-craniocerebral trauma Require careful and continuous observation Common sites Epidural Subdural Intracerebral
place patients at higher risk for hematoma Anticoagulants such as Heparin, Lovenox, ASA, Coumadin as well as bleeding disorders such as Thrombocytopenia, Aplastic Anemia, Hemophilia, Leukemia
Epidural Hematoma Arterial bleeding between the dura and skull Initial unconsciousness-regains consciousness then lapses into coma Headache Ipsilateral pupil changes Contralateral hemiparesis
Epidural hematoma should be considered if lethargy and unconsciousness develop after the pt regains consciousness
Ipsilateral pupil pupil changes on the same side as injury
Contralateral hemiparesis muscle weakness on the opposite site of the hematoma
Subdural Hematoma Venous bleeding between the dura & subarachnoid layers Acute, subacute or chronic bleed Progressive ↓ in LOC Ipsilateral pupil changes ↓ extraoccular muscle movement Periodic episodes of memory lapse, confusion, drowsiness, and personality changes
Suspect subdural hematoma if a patient who has been conscious for several days after an injury has decreased LOC or develops any of the above neurologic signs.
craniocerebral trauma: S&S Signs of ↑ICP Decreased or altered LOC One of the earliest signs May develop rapidly or slowly HA Vomiting (possibly projectile) Changes in VS Signs and Symptoms Nausea Abnormal sensation Bleeding/fluid from nose (rhinorrhea) or ears (otorrhe
Basilar Skull Fracture Signs . Battle’s sign – periauricular ecchymosis - bruising near/of the mastoid process behind the ear. Raccoon eyes – periorbital ecchymosis – bruised area around the eyes.
Cushing’s Triad or Cushing’s Response An important diagnostic sign of late-stage IICP Increased Systolic Blood Pressure.Widening Pulse Pressure (difference between systolic and diastolic measurement) .Bradycardia
Dx tests for craniocerebral trauma Detecting CSF in otorrhea and rhinorrhea drainage Dextrostick Halo sign Tes-tape CT Scan MRI PET Scan
Halo sign Collect droplets on white absorbent pad. Creates a yellow ring that encircles a central red area - indicative of leakage of CSF.
The Computed Tomography (CT) scan and Magnetic Resonance Imaging (MRI) assist in diagnosing Skull fractures and/or embedded skull fragment. Intracranial bleeding. Shifts in brain tissue. Edema at the injury site. Densities that indicate presence/location of hematoma.
A positron emission tomography, or PET, scan an imaging technique that uses positively charged particles (radioactive positrons) to detect subtle changes in the body's metabolism and chemical activities. A PET scan provides a color-coded image of the body's function, rather than its structure.
intraventricular catheter burr hole is drilled through the skull. The catheter is inserted through the brain into the lateral ventricle.
Epidural Sensor inserted between the skull and dural tissue. Less evasive., but cannot remove excess CSF.
Subarachnoid bolt hollow screw in the skull whose tip projects through the dura into the subarachnoid space
Craniocerebral Trauma Medications Administered Reduce cerebral edema & IICP Osmotic diuretics (Mannitol) Corticosteroids (Dexamethasone) Anticonvulsants Dilantin Cerebyx Non opioid analgesics Antipyretics Pegorgotein
Mannitol- Osmotic diuretic for IICP, draw water from the edematous brain tissue.
Dexamethasone Corticosteroids for IICP- anti-inflammatory, must monitor blood sugar levels because the medication can affect carbohydrate metabolism and glucose utilization.
Anticonvulsants to treat or reduce seizures: Phenytoin (Dilantin). Fosphenytoin (Cerebyx)
Created by: jtzuetrong