11 Skull injuriesIt include fractures to the cranium and the face, can be associated with brain injury.It is divided into:Open skull fracture: cranium is fractures and scalp is lacerated.Closed skull fracture: scalp is lacerated but cranium is intact.Basal skull fracture
12 S & S of Skull Fractures and Brain Injuries Visible bone fragmentsAltered mental statusDeep lacerated or severe bruise or hematomaDepression or deformity of the skullSevere pain at site of injuryBattle’s SignUnequal or unreactive pupilsRaccoon’s eyeSunken eyeBleeding from the ears and/or noseClear fluid flow from ears and/or nosePersonality changeIncreased blood pressure, decreased pulse rate and widening pulse pressure (Cushing’s Syndrome)Irregular breathing patternTemperature increaseBlurred or multiple visionImpaired hearing or ringingEquilibrium problemsForceful or projectile vomitingPosturingParalysis or disability on one side of the bodySeizuresDeteriorating vital signs
13 Battle’s signIndication of fracture of middle cranial fossa of the skull, and may suggest underlying brain trauma.It appears as a result of extravasation of blood along the path of the posterior auricular artery
14 Raccoon eyes Raccoon eyes may be bilateral or unilateral If unilateral, it is highly suggestive of basilar skull fracture, with a positive predictive value of 85%Most often associated with fractures of the anterior cranial fossa.
15 CSF rhinorrhea & otorhea Suggestive of basal skull fracture
17 Assessment of TBI ABC Alert Verbal Pain Unresponsive Vital signs GCS : Eye opening, Best motor response and Best verbal responseHistory and mechanism of injury
18 Primary Brain Injuries It occur at the time of original insultDirect damage done to brain parenchyma and associated with vascular injuriesBrain tissue can be lacerated, punctured or bruised by broken bones or foreign bodiesDamage is already doneIrreversibleDamage control (debridement)
19 Secondary Brain Injury Damage that occurs after the initial insult (ongoing injury processes)Expanding mass lesions, swelling or bleeding quickly overwhelm buffersEnd result is increased intracranial pressure (ICP) and/or herniationDiagnosis and treatments target minimizing the effects of these indirect insults
22 Secondary Injury Mechanisms Mass effect and subsequent elevated ICP and mechanical shifting leading to herniationHypoxiaHypotension and inadequate CBFCellular mechanisms
23 Intracranial Causes Herniation: displaced brain parenchyma Damage to brain from trauma against the dura itself as well as producing ischemia as wellCerebral Edema: intracellular fluid collection within neurons and interstitial spaces.Intra-cerebral Hematomas
24 Brain Injuries – Brain Concussion Usually caused by blunt injuries.Injuries patient shows transient alteration in neurologic functionMild injury usually with no detectable brain damage.May have brief loss of consciousness.Headache grogginess and short memory loss are common.
25 Brain Injuries – Brain Contusion A bruised brain or contusion can occur with closed head injuries.Usually caused by blow that causes the brain to hit inside the skullUnconsciousness or decreased level of consciousness can occur
26 Brain Injuries – A hematoma Is a collection of blood within tissue.Hematoma inside the cranium is named according to its location:Subdural hematoma: blood collection between brain and duraEpidural hematoma: blood collection between dura and the skullSubarachnoid Hemorrhage:Intracerebral hematoma: blood collection within the brain
27 Epidural Hematomas Blood between inner table of the skull and the dura Lens shaped hematomas that do not cross suture lines on CT
28 Subdural HematomasBlood beneath the dura, overlying the brain and arachnoid, resulting from tears to bridging vesselsCrescent shaped density that may run length of skullVery common in the elderly
29 Subarachnoid Hemorrhage Bleeding beneath the arachnoid membrane on the surface of the brain.
30 Intracranial Hematoma Focal areas of hemorrhage within the parenchyma
31 ER Care of Skull Fractures and Brain Injuries Take appropriate body substance isolation precautions.Assume spine injuryMonitor conscious patient for changes in breathingApply rigid collar, immobilize the neck and spineAdminister high concentration oxygenControl bleedingKeep patient at restTalk to conscious patient (emotional support)Dress and bandage open woundsMange the patient for shockBe prepared for vomitingTransport patient promptlyMonitor vital signs every five minutes