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TRANSITION SERIES Topics for the Advanced EMT CHAPTER Head and Traumatic Brain Injury 40.

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Presentation on theme: "TRANSITION SERIES Topics for the Advanced EMT CHAPTER Head and Traumatic Brain Injury 40."— Presentation transcript:

1 TRANSITION SERIES Topics for the Advanced EMT CHAPTER Head and Traumatic Brain Injury 40

2 Objectives Discuss the incidence and death rates for brain injuries. Review the pathophysiology behind the types of brain injuries. Define assessment considerations and findings for patients with brain injuries. Review current treatment standards for brain injuries.

3 Introduction Brain injuries may manifest themselves now, or weeks later. The physiology of the brain and surrounding structures leaves itself open to certain types of brain injuries.

4 Introduction (cont’d) The task for the Advanced EMT is to understand the physiology of the brain and pathophysiology of brain injuries to provide optimal treatment.

5 Epidemiology 1.5 million head injuries occur per year in the U.S. It is the leading cause of death in accident victims younger than 45. 50,000 people die each year from brain injury.

6 Pathophysiology Intracerebral hemorrhage –Extraaxial hemorrhage  Epidural, subdural, subarachnoid –Intraaxial hemorrhage  Occurs within brain tissue itself  Intracerebral hemorrhage –Intraparenchymal hemorrhage –Intraventricular hemorrhage

7 Pathophysiology (cont’d) Diffuse axonal injury (DAI) –Most devastating of traumatic brain injuries –Acceleration-deceleration mechanism –Frequent outcome is coma –Stretching and swelling of axons

8 Pathophysiology (cont’d) Concussion  Mild DAI  GCS 13-15 –Epidural hematoma  Serious complication of head injury  Bleeding between dura and skull

9 Epidural hematoma

10 Pathophysiology (cont’d) Subdural hematoma  Bleeding between arachnoid and dura  Low-pressure bleed  Acute, subacute, chronic

11 Subdural hematoma

12 Pathophysiology (cont’d) Subarachnoid hemorrhage  Brain tissue becomes ischemic  Severe headache common  May rapidly progress to seizures and cardiac arrest

13 Assessment Findings Dispatch information –Seizures, headache, trauma, etc. Soft-tissue injuries to skull Closed or open skull injuries Alteration in mental status

14 Assessment Findings (cont’d) Possible loss of airway patency Breathing may become irregular and slow Changes to vitals (Cushing response)

15 Assessment Findings (cont’d) Response to painful stimuli –Purposeful vs. nonpurposeful –Decorticate vs. decerebrate

16 Nonpurposeful responses to painful stimuli include (a) flexion (decorticate) posturing and (b) extension (decerebrate) posturing.

17 Assessment Findings (cont’d) Assess and reassess mental status. –Compute GCS, look for trends.

18 Glasgow Coma Scale

19 Assessment Findings (cont’d) Assess vital signs –Trends of vitals may also help identify brain injury.

20 Implications of Changes in Vital Signs with Head Injuries.

21 Emergency Medical Care Manual cervical spine considerations Assess and maintain the airway. Determine breathing adequacy. –High-flow via NRB with adequate breathing. –High-flow via PPV @ 10-12/min if inadequate. –Avoid intubating head injured patients unless apneic – tend to worsen outcomes.

22 Emergency Medical Care –Consider hyperventilation with brain herniation. –Do not routinely hyperventilate – Reserve for signs of herniation  Controversial  May produce short-term improvement  No role in long-term mgt of elevated ICP  May produce vasoconstriction and worsening of brain injury – use only when concerned about herniation.

23 Emergency Medical Care (cont’d) Assess circulatory components. –Check pulse, skin characteristics. –Control major bleeds.

24 Emergency Medical Care (cont’d) Transport immediately to an appropriate medical facility. –Initiate a large-bore intravenous catheter. –Administer fluids to keep SBP >90 mmHg. –Do not cause hypertension with IV fluids.

25 Emergency Medical Care (cont’d) Be prepared to manage seizure activity. Constantly monitor airway, breathing, and circulation. Mental status changes are key to determining improvement or deterioration.

26 Case Study You are called to a motorcycle accident where a rider not wearing a helmet lost control of his cycle on a turn and hit a tree. When you arrive, the patient is lying supine, blood covering his face and shirt, and the patient is actively seizing. PD is already on scene and you can hear the wail of the FD sirens approaching.

27 Case Study (cont’d) Scene Size-Up –Standard precautions taken. –Scene is safe, police stopped traffic on road. –43-year-old male patient, 200 lbs. –Patient found supine, blood on face and shirt.

28 Case Study (cont’d) Scene Size-Up –Patient entry made, egress not problematic. –Paramedic summoned now for backup assistance. –PD on scene, FD pulling up.

29 Case Study (cont’d) Primary Assessment Findings –Patient unresponsive, active tonic-clonic seizures. –Mouth clenched shut, blood on face, sonorous breath sounds with gurgling. –Breathing is ineffective due to seizure activity.

30 Case Study (cont’d) Primary Assessment Findings –Carotid and radial pulses present. –Peripheral skin warm and sweaty. –No major bleeds noted to body.

31 Case Study (cont’d) Is this patient a high or low priority? Why? What interventions should be provided at this time?

32 Case Study (cont’d) Medical History –Unknown Medications –Unknown Allergies –Unknown

33 Case Study (cont’d) Pertinent Secondary Assessment Findings –Pupils unequal, sluggish to light. –Airway patent, breathing still ineffective. –Patient is still unresponsive and seizing. –Pulse oximeter reading 82% with attempts at PPV.

34 Case Study (cont’d) Pertinent Secondary Assessment Findings –B/P 198/90, heart rate 64, spontaneous respirations 4 and irregular. –Crepitus noted to posterior vertebrae. –Depressed right frontal skull fracture noted.

35 Case Study (cont’d) What type of brain injury could this be? Is this patient displaying any indications of herniation?

36 Case Study (cont’d) Care provided: –Patient’s cervical spine manually immobilized. –High-flow oxygen via PPV. –Airway suctioned with catheter, manual airway technique applied.

37 Case Study (cont’d) Care provided: –Following cessation of seizure, full body immobilization provided. –Expeditious transport to appropriate facility. –Initiation of intravenous access.

38 Summary Brain injuries are a common cause of death and disability following traumatic events. Prehospital recognition and proper management can help reduce the long- term effects of brain injuries. As with any trauma, focus first on supporting lost function.

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