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head injury
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MR.JERRY JAMES
NURSING EDUCATOR
INSTITUTE OF HEALTH ANDMANAGEMENT
TRAUMATIC HEAD AND SPINAL CORD INJURY
Deformation
Acceleration-deceleration
Rotation
MECHANISM OF INJURY
1.DIRECT HEAD INJURY
CLASSIFICATION OF HEAD INJURY
2. INDIRECT HEAD INJURY
OPEN HEAD INJURY
CLOSED HEAD INJURY
COUP AND COUNTERCOUP INJURY
1.SCALP INJURY
ABRASIONS
CONTUSIONS
LACERATION
CLASSIFICATION BASED ON THE LOCATION
2.SKULL FRACTURE
a. Linear fracture
b. Depressed skull fracture
c. Diastatic skull fracture
d. Basilar skull fracture
e. Cranial burst skull fracture
f. Compound skull fractures
2. MENINGEAL INJURIES
1.CONCUSSION
Typical signs.
• Altered level of consciousness
• Amnesia
• headache
2.CONTUSION
Typical signs
• Hemorrhage
• Infarction
• Necrosis
• Edema
• Seizure
• Increased I.C.P
3.CEREBRAL INJURIES
SPINAL CORD INJURY
1. Hyper flexion
2. Hyperextension
CLASSIFICATION OF SPINAL CORD INJURY
3. Compression injury
4.Rotational injuries
5.Penetrating injury
• COMPLETE INJURY
• INCOMPLETE INJURY
CLASSIFICATION BY DEGREE OF INJURY
1.Central cord syndrome
• Motor deficits in the upper extremities
• Less impairment in leg movements
• Sensory loss below the site of injury
• Loss of bladder control may occur
INCOMPLETE INJURY
2. Anterior cord syndromeLoss of perception of pain, temperature and motor
function is noted below the level of the lesion
3. Brown sequard syndrome
4. Conus medullaris and Cauda equina syndrome
• Lower extremity dysfunction
• Loss of bladder and anal sphincter
• function
• Male sexual dysfunction
• Loss of achilles reflex
Road traffic accident
Fall from higher place
Athletic accidents
Blast injuries
Anti coagulant and anti platelet medications
Occupational accidents
penetration
ETIOLOGICAL FACTORS
Brain suffers traumatic injury
Brain swelling or bleeding increase intra cranial volume
Intra cranial pressure increases
Pressure on blood vessels with in the brain increases
Decreased blood flow to the brain
Cerebral hypoxia and ischemia occur
Herniation of the brain
Brain death
PATHOPHYSIOLIOGY OF BRAIN TRAUMA
Hemorrhage
RBC and platelet break down of RBC
Aggregation
Free radical formation
Release of nor epinephrine
Serotonine,dopamine secondary injury
Vasoconstriction spinal edema, tissue hypoxia
Thrombosis formation
SC blood flow
PATHOPHYSIOLOGY OF SPINAL CORD INJURY
HEAD TRAUMA
Altered level of consciousness
Confusion
Pupillary abnormalities
Altered or absent gag and corneal reflex
Sudden onset of neurological onset
Changes in vital signs
Spasticity
Vertigo
Seizures
Ottorhoea
Rhinorrhoea
Slurred speech
CLINICAL MANIFESTATIONS
SPINAL CORD INJURY
Spinal shock and neurogenic shock
Respiratory distress
Bradycardia
Poikilothermism
Low blood pressure
Loss of bowel or bladder control
Loss of sensation, including the ability to feel heat, cold and touch
Difficulty with balance and walking
Loss of movement
Spinal edema
CERVICAL INJURIES
C-1/C-2 levels will often result in loss of breathing
C3 vertebrae and above : Typically results in loss of diaphragm function
C4 : Results in significant loss of function at the biceps and shoulders.
C5 : Results in potential loss of function at the biceps and shoulders, and complete loss of function at the wrists and hands.
C6 : Results in limited wrist control, and complete loss of hand function
C7 and T1 : Results in lack of dexterity in the hands and fingers, but allows for limited use of arms
THORACIC INJURIES
T1 to T8 : Results in the inability to control the abdominal muscles
T9 to T12 : Results in partial loss of trunk and abdominal muscle control.
LUMBOSACRAL INJURIES
Dysfunction of the bowel and bladder
Sexual dysfunction
Hisory collection
Physical examination
Neurological examination
Ct and m.R.I
Pet scan
Nerve conduction studies
Transcranial doppler studies
X ray
Blood investigation
DIAGNOSTIC FINDINGS
AMERICAN SPINAL INJURY ASSOCIATION SCALE
‘ASIA’ SCALE
A. Complete Complete loss of sensory and motor function
b. incomplete Sensory function is preserved but no motor function
c. incomplete Motor function is preserved and muscle grade more than 3
d. incomplete Motor function is preserved and muscle grade more than 3
e. normal Motor and sensory function are normal
2/2/2 rule
1. Patient die in 2 mins from airway and breathing compromise and hypovolemic shock
2. Patient die in 2 hrs from hypovolemic shock
3. Patient die in 2 weeks from septic shock
MANAGEMENT
Management of trauma patient can be divided in to 2 phase
• Primary phase
• Secondary phase
MANGEMENT
A - AIRWAY
B- BREATHING’
C- CIRCULATION
D- DISABILITY
E- EXPOSURE
PRIMARY SURVEY
AIRWAY
Assessment
Can the patient talk
Is the patient voice normal
Stridor
Foreign body
Bleeding and secretions
Mandibular or laryngeal fracture
INTERVENTIONS
1. Cervical spine stabilization
2. Sedation
3. Jaw thrust
4. Suction
5. Pulse oximetry
6. Oxygen administration
7. Endotracheal intubation
8. Arterial blood gas analysis
BREATHING
Assessment:
LOOK the movement of the chest
Respiratory rate
Flail chest
Cyanosis
Foreign object
INTERVENTIONS
• Oxygen administration
• Endotracheal intubation
• Arterial blood gas analysis
• Mechanical ventilation
• Inter costal drainage
SHOCK
Clinical findings
• Hypotension
• Tachycardia or bradycardia
• Tachypnea
CIRCULATION
CIRCULATION
ASSESSMENT
• External hemorrhage
• Penetrating trauma
• Blunt trauma
• Head injury
• hypotension
INTERVENTIONS
Intravenous fluids
Massive transfusion
Direct manual pressure
Hyperventilation
Mannitol
Anticonvulsants
positions
DISABILITY
Life threatening disability
• Spinal cord transection
• Intracerebral or intracranial hemorrhage
• Cerebro vascular injury
INTERVENTIONS
• Mobilization
• Neurological assessment
• Glasgow coma scale
‘AVPU’ ASSESSMENT
A- AWAKE
V-VERBAL RESPONSE
P-PAINFUL RESPONSE
U-UNRESPONSIVE
DISABILITY ASSESSMENT
EXPOSURE
Undress the patient and look for injury
Immobilization
Cover the patient with warm blanket
IV fluids
Patient privacy
LOG ROLLING
LIFTING AND HANDLING THE PATIENT
Step 1.
‘SAMPLE HISTORY’
S- signs and symptoms
A- allergies
M- medication currently used
P- past illness
L- last meal
E- events/ environment related injury
SECONDARY SURVEY
NURSING MANAGEMENT
Monitoring for neurological function
Maintaining the airway
Monitoring fluid and electrolyte balance
Promoting adequate nutrition
Preventing injury
Maintaining body temperature
Maintain skin integrity
• Drug management
Methylprednisolone (Medrol)
Atropine and dopamine
Anti coagulants
Sedatives
Analgesics
Osmotic diuretics
Deep vein thrombosis prophylaxis
I.V fluids
• Craniotomy or craniectomy
• Decompression laminectomy
NON SURGICAL MANAGEMENT
• The halo and vest system
• Cervical traction
SURGICAL MANAGEMENT