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Head trauma
- 2. Head Trauma - 2
- 3. Glasgow Coma Scale Suspect severe brain injury GCS <9 *Decorticate posturing to pain **Decerebrate posturing to pain Head Trauma - 3
- 4. Level Of Consciousness • Glasgow Coma Scale Eye Opening Best Verbal Best Motor Spontaneous 4 Oriented 5 Obeys Command 6 To Voice 3 Confused 4 Localizes To Pain 2 Inappropriate 3 Withdraws 4 None 1 Incomprehensible 2 Flexion 3 None Extension 2 None 1 1 5
- 5. Head Injury • Any trauma to the scalp, skull, or brain • Head trauma includes an alteration in consciousness no matter how brief
- 6. Head Injury • Causes – Motor vehicle accidents – Firearm-related injuries – Falls – Assaults – Sports-related injuries – Recreational accidents
- 7. Head Injury • High potential for poor outcome • Deaths occur at three points in time after injury: – Immediately after the injury – Within 2 hours after injury – 3 weeks after injury
- 8. Epidural and Subdural Hematomas Epidural Hematoma Subdural Hematoma Fig. 55-15
- 9. Epidural Hematomas • Blood between inner table of the skull and the dura • Lens shaped hematomas that do not cross suture lines on CT
- 10. Clinical Features In Head Trauma • • • • • • • Scalp Injuries Skull Fractures Depressed Skull Fractures Basilar Skull Fractures Vascular Injuries Penetrating Head Injury Intracranial Hemorrhage – – – – Epidural Hematoma Subdural Hematoma Subarachnoid Hemorrhage Intracerebral Hemorrhage
- 11. Skull injuries • It 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. Clinical Features • Moderate – – – – GCS = 9-13 Clinical presentation varies widely 10% of patients Specialized Subset = “Talk and Die Syndrome” • • • • Initially, talkative and without significant signs of external injury Within 48 hours of injury, rapidly deteriorate Epidural Hematoma is cause in 78-80% of cases Patients with “talk and die syndrome” who present with a GCS > 9 but who deteriorate have been shown to have a worse outcome than patients who present with severe TBI at outset – ? Delayed Diagnosis Ghana Emergency Medicine Ghana Emergency Medicine Collaborative Collaborative Advanced Emergency Trauma Course Advanced Emergency Trauma
Notes de l'éditeur
- IMAGE: Raccoon eyes and CSF leak from nose, indicative of anterior basilar skull fracture.
- IMAGE: Table 10-2: Glasgow Coma Scale (on page 154).NOTE: See also Appendix F: Trauma Scoring in the Prehospital Care Setting.In TBI patient, a Glasgow Coma Scale score of 8 or less is considered evidence of a severe brain injury. GCS score that is determined in field serves as baseline for patient; be sure to record it. Record score for each part of GCS, not just total score. Perform a finger-stick glucose on all patients with altered mental status.