We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!
Presentation is loading. Please wait.
Published byIsabell Mellas
Modified about 1 year ago
Committee on Trauma Presents ©ACS Head Trauma Head Trauma
Objectives Describe basic intracranial physiology. Recognize the importance of limiting secondary brain injury. Perform a focused neurologic exam. Stabilize and arrange for definitive care. ©ACS
Key Questions What are the unique features of brain anatomy and physiology and how do they affect patterns of brain injury? What is a focused neurologic exam? What is optimal management of the brain-injured patient? How do I diagnose brain death? ©ACS
Rigid, nonexpansile skull filled with brain, CSF, and blood CBF autoregulation Autoregulatory compensation disrupted by brain injury Mass effect of intracranial hemorrhage ©ACS Anatomy and physiology effects?
Monro-Kellie Doctrine ©ACS Ven. Vol. Art. Vol. BrainCSFMass Arterial Volume BrainCSF 75 mL Mass 75 mL Venous Volume Art. Vol. Brain CSF
Volume – Pressure Curve ©ACS Volume of Mass ICP (mm Hg) Compensation Herniation Point of Decompensation
Intracranial Pressure (ICP) 10 mm Hg=Normal > 20 mm Hg=Abnormal > 40 mm Hg=Severe Many pathologic processes affect outcome Sustained ICP leads to brain function and outcome ©ACS
Cerebral Perfusion Pressure* ©ACS * CPP Cerebral Blood Flow MBPICPCPP Normal Cushing’s Response Hypotension – =
Autoregulation If autoregulation is intact, CBF is maintained with a mean BP of 50 to 160 mm Hg. Moderate or severe brain injury: Autoregulation often impaired Brain more vulnerable to episodes of hypotension secondary brain injury ©ACS
Mild Brain Injury ©ACS GCS Score = 14–15 History Exclude systemic injuries Neurologic exam X-rays as indicated Alcohol / drug screens as indicated Liberal use of head CT Observe or discharge based on findings
Moderate Brain Injury ©ACS GCS Score = 9–13 Initial evaluation same as for mild injury CT scan for all Admit and observe Frequent neurologic exams Repeat CT scan Deterioration: Manage as severe head injury
Severe Brain Injury GCS Score = 3–8 Evaluate and resuscitate Intubate for airway protection Focused neurologic exam Frequent reevaluation Identify associated injuries ©ACS
Classification of Brain Injury ©ACS By Mechanism Blunt: High and low velocity Penetrating: GSW and other
Classification of Brain Injury ©ACS By Morphology: Skull Fractures Vault Basilar With / without CSF leak With / without cranial palsy Depressed / nondepressed Open / closed
Classifications of Brain Injury ©ACS By Morphology: Brain Focal Diffuse Epidural (extradural) Subdural Intracerebral Concussion Multiple contusions Hypoxic / ischemic injury
Diffuse Brain Injury Mild concussion Severe, ischemic insult ©ACS Normal CT Diffuse Injury
Contusion / Hematoma Coup / contracoup injuries Most common: Frontal / temporal lobes CT changes usually progressive Most conscious patients: No operation ©ACS
Contusion / Hematoma ©ACS Large frontal contusion with shift
Epidural Hematoma Associated with skull fracture Classic: Middle meningeal artery tear Lenticular / biconvex Lucid interval Can be rapidly fatal Early evacuation essential ©ACS
Epidural Hematoma Uncal herniation Temporal Epidural Hematoma ©ACS
Subdural Hematoma Venous tear / brain laceration Covers cerebral surface Morbidity / mortality due to underlying brain injury Rapid surgical evacuation recommended, especially if > 5 mm shift of midline ©ACS
Subdural Hematoma ©ACS
Priorities ABCDE ©ACS Minimize secondary brain injury Administer O 2 Maintain blood pressure (systolic > 90 mm Hg)
Focused Neurologic Exam? GCS Score ©ACS Consult neurosurgeon early Pupils Lateralizing signs
Indications for CT Scan? ©ACS All patients with suspicion of brain injury
Medical Management Controlled ventilation ©ACS Intravenous fluids Euvolemia Isotonic Goal: Paco 2 at 35 mm Hg
Medical Management ©ACS Mannitol Use with signs of tentorial herniation Dose: 1.0 g / kg IV bolus Consult with neurosurgeon first
Medical Management Other medications ©ACS Anticonvulsants Sedation Paralytics
Surgical Management ©ACS Scalp Injuries Possible site of major blood loss Direct pressure to control bleeding Occasional temporary closure
Surgical Management ©ACS Intracranial Mass Lesion May be life-threatening if expanding rapidly Immediate neurosurgical consult Hyperventilation / Mannitol Damage control craniotomy: Transfer to neurosurgeon (rural / austere areas)
Diagnose brain death? ClinicalAncillary Studies ©ACS GCS Score = 3 Nonreactive pupils Absent brainstem reflexes No spontaneous ventilatory effort EEG: No activity Brain scan: No flow ICP > MAP x 3 hours No cardiac response to atropine Remember, organ donation
Summary: What should I do? Maintain mean BP > 90 mm Hg Maintain Paco 2 near / at 35 mm Hg Use isotonic solution for euvolemia Frequent neurologic exams Liberal use of CT scans Early neurosurgical consult ©ACS
Summary: What should I not do? Allow patient to become hypotensive Over-aggressively hyperventilate Use hypotonic IV fluids Use long-acting paralytics Paralyze before performing complete exam Depend on clinical exam alone ©ACS
PTC HEAD TRAUMA By Dr. Vashdev FCPS, Consultant Neuro and Spinal Surgeon & DEPARTMENT OF NEUROSURGERY LIAQUAT UNIVERSITY OF MEDICAL AND HEALTH SCIENCES.
HEAD TRAUMA 1 Instructor Name: Title: Unit:. OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment.
Head Injury Saurabh Sinha Department of Clinical Neurosciences Western General Hospital.
CHAPTER 6 HEAD TRAUMA. OBJECTIVES u A.Understand basic intracranial anatomy & physiology u B.Evaluate a patient with a head injury u C.Perform the necessary.
Head Trauma. Head Injuries: Account for about one half of all trauma deaths Survivors range from baseline function to severe morbidity Even “minor”
Basic Trauma Course HEAD/FACIAL TRAUMA. Head injuries are most often caused by Motor Vehicle Crashes (MVC), especially in teens and young adults.
An Overview of Head Injury Management Eldad J. Hadar, M.D. Department of Neurosurgery.
International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Head Trauma 10.
Head Trauma. Anatomy of Nervous System The nervous system is composed of Brain Spinal cord The nervous system is divided into: Central nervous.
A&E(VMH) Head injury Dr. B.Padmashini Department of Accident, Emergency & Critical Care Medicine. Vinayaka Mission Kirupananda Variyar Medical College.
A&E(VMH) Head injury. A&E(VMH) Head Injury Number One Killer in Trauma Number One Killer in Trauma 25% of all trauma deaths 25% of all trauma deaths 50%
Hugo Poncia. Head Trauma Epidemiology Physiology History Examination Investigations Treatments Cases.
Traumatic Brain Injury Gill Sviri MD, M.Sc. Contents ► Epidemiology ► Biomechanics of primary brain injury ► Mechanisms of secondary brain injury ► Clinical.
Intracranial hematomas. Intracerebral hematoma They are due to areas of contusions coalescing into contusional hematoma These appear as hyperdense lesions.
Adult Medical-Surgical Nursing Neurology Module: Head Injury.
CRANIOCEREBRAL TRAUMA. Etiology/Pathophysiology HEAD INJURY Causes death or serious disability. Second most commom cause of neurological injuries. Major.
Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction Chapter 17 Mosby items and derived items © 2010, 2006 by Mosby,
Campbell, International Trauma Life Support, 6th Ed. © 2008 Pearson Education, Inc., Upper Saddle River, NJ International Trauma Life Support for Prehospital.
Head Trauma 181 st INF BDE Combat Lifesaver Plus 181 st INF BDE Combat Lifesaver Plus.
Classification of Head Injuries Scalp Injuries Scalp Injuries Skull Injuries Skull Injuries Intra-cranial Injuries (Brain Injuries) Intra-cranial Injuries.
Head injury is an injury to the scalp, skull, or brain. The most important consequence of head injery is traumatic brain injury. Head injury may.
Head trauma Trauma department Hsinglin Lin. Introduction Adequate oxygenation Maintenance of sufficient blood pressure Avoid secondary brain damage Early.
Management of Intracranial Hypertension in Traumatic Brain Injury Management of Intracranial Hypertension in Traumatic Brain Injury Kiran Hebbar, MD 5/31/05.
Initial Assessment and Management Presented by Abdulgadir F. Bugdadi.
Intracranial Haemorrhages Sanjaya Adikari Department of Anatomy.
Michelle Biros, MD Evaluation & Management of Severe Traumatic Brain Injury Patients with Suspected Elevated ICP.
Head injuries. A head injury is any trauma that leads to injury of the scalp, skull, or brain. These injuries can range from a minor bump on the skull.
Intracranial hemorrhages Siti hazaimah. Intracranial hemorrhages Classification in function of location: - Epidural - Subdural - Subarachnoid - Intracerebral/
Head Injury (TBI) M K Alam, MS; FRCSEd. Head Injury (TBI) The most common cranial condition. Decline in mortality: 50% 1970s to 36% 1980s to 27% 1990s.
CROSS-SECTION HEAD INJURY - DEFINITION Any injury that results in trauma to the SCALP, SKULL or BRAIN. TRAUMATIC BRAIN INJURY and HEAD INJURY are often.
PEDIATRIC HEAD INJURY Myra Lalas Pitt. P EDIATRIC H EAD I NJURY More than 1.5 million head injuries occur in the US annually 2M: 1F Motor vehicle collisions-
Intracranial Pressure Paula Ponder MSN, RN, CEN (Relates to Chapter 62,63 Intracranial Pressure in the textbook)
Neurologic Trauma Bryan E. Bledsoe, DO, FACEP. Neurologic Trauma.
Mechanical Injuries Of Brain and Meniges. 1 ๐ Traumatic Lesions 1 ๐ Traumatic Lesions 2 ๐ Alterations 2 ๐ Alterations.
HEAD INJURIES Ms.Rinta Rajan MSN (CVTS). HEAD INJURY/TRAUMATIC BRAIN INJURY Traumatic brain injury is an insult to the brain that is capable of producing.
Managing Increased Intracranial Pressure. Introduction The cranium is a rigid compartment. Contains the brain, vessels and cerebrospinal fluid. Can not.
Management of Head Injuries. The key aspects in the management of head injury The key aspects in the management of head injury Accurate clinical assessment.
Central Nervous System Trauma Estrada Bernard, MD Division of Neurosurgery UNC Chapel.
CT scan in head and spine injuries BY : DR AHMED MOHAMMED DEBES سایت جامع رادیولوژی
Decompressive craniectomy: Indication, technique, present status and controversies.
Epidural and Subdural Hematoma Kelly Kirby Jenna Baraki.
Intracranial Pressure Monitoring Definition: pressure exerted by intracranial volume of: 1- Brain 2- Blood 3- CSF Normal ICP: mm Hg. Increased.
Intracerebral Hemorrhage Dr. Bashar Shaker. Intracerebral hemorrhage is focal bleeding from a blood vessel in the brain parenchyma. The cause is usually.
Mallika Khwanmuang Phatcharapol Udomluck Jitsupa Litleangdej th year medical students.
Nursing Management: Acute Intracranial Problems Chapter 57 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Increased Intracranial Pressure (ICP) Dr. Isazadehfar.
Head Trauma Head Trauma Facts: 40% of multiple trauma victims have brain injuries. Brain injured patients have a death rate twice that of non-brain.
In a traumatic brain injury event, the ___________ head injury is often more damaging than the ___________ head injury. Jared hit his ___________ lobe.
ICP AND MANAGEMENT July OUTLINE Intracranial contents Intracranial contents Monroe-Kellie Doctrine Monroe-Kellie Doctrine ICP monitors and waveforms.
CASE SIMULATION Debriefing. Diagnosis? Altered level of consciousness Respiratory insufficiency Acute subdural hematoma Possible inflicted traumatic brain.
© 2017 SlidePlayer.com Inc. All rights reserved.