Get Started. It's Free
or sign up with your email address
Head injury . by Mind Map: Head injury .

1. RTA - Sport injuries - Fall

1.1. Traumatic brain injuries

1.1.1. Types A) Primary Diffuse Focal B) Secondary altered cerebral perfusion

2. increase ICP

3. increase metabolic demands

4. convulsion

5. shivering

6. pain and stress

7. Hyperpyrexia

8. Cerebral edema

9. hypoxia

10. Factors decrease venous drainge

11. intracranial bleeding

12. hypercarbia

13. Signs and Symptoms

13.1. headache

13.2. occular signs

13.3. projectile vomiting

13.4. Cushing triad which is a late sign of increased ICP

13.4.1. bradycardia

13.4.2. increase systolic BP

13.4.3. irregular breathing

13.5. Decrease at motor strength and function

14. how to Maintain cerebral tissue perfusion

14.1. Maintain mean arterial blood pressure

14.1.1. MAP=((2xdiastolic)+systolic/3

14.1.2. MAP= 1/3x (systole- diastole)+diastole

14.1.3. monitor vital signs

14.1.4. monitor intake and output

14.1.5. IV solutions should be administered at slower rate

14.1.6. Isotonic saline is preferable and glucose containing solutions are not recommended

14.1.7. osmotic diuretic , inotropic and vasopressor medications prescribed

14.1.8. blood products replacement

14.2. maintain ABG

14.2.1. maintain a patent airway by insert OPA or suction

14.2.2. Administer oxygen therapy or M,V then adjust PaO2 at 100mmHg and PaCO2 at 30-35mmHg

14.2.3. correct anemia

14.2.4. prevent aspiration and DVT

14.2.5. Normoglycemia reduce solutions contain dextrose monitor glucose frequently administer insulin according to need

14.3. Decrease metabolic demands

14.3.1. monitor temperature- WBCs- cultures

14.3.2. maintain normothermia

14.3.3. prevent shivering

14.3.4. prevent and early detect infection

14.3.5. seizure prevention or control

14.3.6. pain management

14.4. promote venous drainage to prevent increase ICP

14.4.1. monitor s&s of increased ICP

14.4.2. positioning head of bed elevated 30 degree avoid activities increase ICP never place pt at head low position maintain head at neutral position avoid flexion or twisting of neck or hip change position/2hrs when moving conscious patient tell him not to push with feet

14.4.3. care of ETT or TT

14.4.4. maintain cervical immobilization by neck collar

14.4.5. prevent valsalva maneuvars ( sneezing- coughing- staining) use laxatives eat fibers food

14.4.6. avoid use of enemas

14.4.7. NGT drainage

15. Diagnostic test

15.1. X-Ray

15.2. MRI

15.3. CT

15.4. cerebral and carotid angiography

16. Blunt or penetrating trauma

16.1. Scalp wound

16.1.1. Management 1- immobilization. 2- palpate for skull trauma. 3- Apply indirect pressure to stop bleeding and avoid pressure at depressed area. 4- Manage hypovolemia. 5- Cleansing and debridement of wound.

17. Fracture at skull bone

17.1. Skull Fracture

17.1.1. types 1- linear or simple. The bone isn't displaced. Don't need special care. 2- Depressed. depression of bone. Common on children ( softer skull ). if depression more than 5mm needs surgical elevation to prevent infection and brain contusion. Management 3- Base of skull. Signs and symptoms: Management

18. Assessment

18.1. GCS

18.1.1. mild 13-15

18.1.2. moderate 9-12

18.1.3. Severe 3-8

18.2. pupil size and reaction

18.3. Reflexes

18.4. cranial nerve assessment

19. initial management of brain trauma

19.1. Airway , Breathing , spine

19.1.1. Spinal immobilization

19.1.2. maintain Pa02 at 100mmHg and o2 saturation ar 95% and PaCo2 at 35-38mmHg

19.1.3. Assess airway patency and secure airway check response observe chest movement or auscult breathing sound over 10sec

19.1.4. assess indicators of airway obstruction tachypnea or apnea use of accessory muscle increase respiratory effort intercostal retraction noisy respiration central cyanosis or pallor

19.1.5. if airway is compromised perform jaw thrust insert ETT if GCS 8 or less but avoid nasal suction insert orogastric tube to decompress stomach to prevent abdominal pressure thus decrease ICP cover wound if present assist on needle thoracotomy or ICT insertion Administer humidified o2 ot MV

19.2. Circulation

19.2.1. Assessment of pulse rate and rhythm bleeding skin color and temperature capillary refill Blood pressure

19.2.2. obtain a minimum 2 large vascular access

19.2.3. obtain blood sample fro blood group and cross matching

19.2.4. administer warm lactated ringer or NS or blood product as needed

19.2.5. prepare for pericardiocentesis or thoractomy at cardiac tamponade

19.3. Disability

19.3.1. Assess pupil size and reaction

19.3.2. Assess LOC

19.4. Exposure and environmental control

19.4.1. expose pt to detect missed wounds

19.4.2. keep pt warm and with clean skin