Professional Documents
Culture Documents
I. HEAD INJURIES
• Includes injury to the scalp, skull, or brain
Pathophysiology
Primary Injury – The initial damage to the brain that results from traumatic
events. (Contusions, lacerations, torn blood vessels from impact, foreign object
penetration.)
Secondary Injury – An insult to the brain subsequent to the original traumatic
event
Head Injury
Increase ICP
Ischemia / Infarction
Brain Death
A. Scalp Injury
• A minor head injury
• Trauma may result in abrasion, contusion, laceration, or hematoma beneath
the layers of tissue of scalp
• The area is irrigated before laceration is sutured to remove foreign materials
and to remove foreign infections
• Subgaleal Hematoma – Hematomas below the outer covering of the skull
B. Skull Fractures
• A break in the continuity of the skull caused by forceful trauma
• May occur with or without damage to the brain
• Classified as: linear, comminuted, depressed, basilar
Clinical Manifestations
• Battle’s sign – An area of bruising may be seen over the mastoid
• CSF otorrhea – CSF escapes from the ears (suspected of basal skull fractures)
• CSF rhinorrhea – CSF escapes from nose
• Halo sign – Blood stain surrounded by a yellowish stain (suggestive of CSF
leak)
Medical Managements
• After the skull fragments are elevated, the area is debrided
• Large defects can be repaired immediately with bone or artificial grafts
• Nasopharynx and external ear should be kept clean (to asses CSF leakage)
• The head is elevated 30 degrees
D. Intracranial Hemorrhage
• Major symptoms are frequently delayed until the hematoma is large enough to
cause distortion of the brain and increased ICP
1. Epidural Hematoma
• Collection of blood in the epidural space between the skull and the
dura
• Usually, there is a momentary loss of consciousness at the time of
injury, followed by an interval of apparent recovery.
• Treatment consists of making openings through the skull (burr
holes) to decrease ICP emergently, remove the clot and control the
bleeding
2. Subdural Hematoma
• A collection of blood between the dura and the brain, a space
normally occupied by a thin cushion of fluid
• The most common cause is trauma, but it may also occur from
coagulophaties or rupture from an aneurysm
2 Categories of SCI
• Primary injuries – result of the initial insult or trauma and are usually
permanent
• Secondary injuries – the result of a contusion or tear injury in which the nerve
fibers begins to swell and disintegrate.
Clinical Manifestations
Types of Injury
• Incomplete spinal cord lesion
• Complete spinal cord lesion
1. Paraplegia – paralysis of the lower body
2. Quadriplegia – paralysis of all four extremities
Effects of SCI
• Central Cord Syndrome
- Motor deficits in the upper extremities, bowel or bladder dysfunction.
- Caused by injury or edema of the central cord, usually of the cervical area
Emergency Management
• Initial care must include rapid assessment, immobilization, extrication,
stabilization or control of life-threatening injuries, and transportation to the
most appropriate medical facility
• At the scene of injury, the patient must be immobilized on a spinal board,
with head and neck in neutral position
• Control patient’s head to prevent flexion, rotation, or extension
• Patient must always be maintained in extended positon