1. Diagnostic test
1.1. X-Ray
1.2. MRI
1.3. CT
1.4. cerebral and carotid angiography
2. Blunt or penetrating trauma
2.1. Scalp wound
2.1.1. Management
2.1.1.1. 1- immobilization.
2.1.1.2. 2- palpate for skull trauma.
2.1.1.3. 3- Apply indirect pressure to stop bleeding and avoid pressure at depressed area.
2.1.1.4. 4- Manage hypovolemia.
2.1.1.5. 5- Cleansing and debridement of wound.
3. Fracture at skull bone
3.1. Skull Fracture
3.1.1. types
3.1.1.1. 1- linear or simple.
3.1.1.1.1. The bone isn't displaced.
3.1.1.1.2. Don't need special care.
3.1.1.2. 2- Depressed.
3.1.1.2.1. depression of bone.
3.1.1.2.2. Common on children ( softer skull ).
3.1.1.2.3. if depression more than 5mm needs surgical elevation to prevent infection and brain contusion.
3.1.1.2.4. Management
3.1.1.3. 3- Base of skull.
3.1.1.3.1. Signs and symptoms:
3.1.1.3.2. Management
4. RTA - Sport injuries - Fall
4.1. Traumatic brain injuries
4.1.1. Types
4.1.1.1. A) Primary
4.1.1.1.1. Diffuse
4.1.1.1.2. Focal
4.1.1.2. B) Secondary
4.1.1.2.1. altered cerebral perfusion
5. increase ICP
6. increase metabolic demands
7. convulsion
8. shivering
9. pain and stress
10. Hyperpyrexia
11. Cerebral edema
12. hypoxia
13. Factors decrease venous drainge
14. intracranial bleeding
15. hypercarbia
16. Signs and Symptoms
16.1. headache
16.2. occular signs
16.3. projectile vomiting
16.4. Cushing triad which is a late sign of increased ICP
16.4.1. bradycardia
16.4.2. increase systolic BP
16.4.3. irregular breathing
16.5. Decrease at motor strength and function
17. how to Maintain cerebral tissue perfusion
17.1. Maintain mean arterial blood pressure
17.1.1. MAP=((2xdiastolic)+systolic/3
17.1.2. MAP= 1/3x (systole- diastole)+diastole
17.1.3. monitor vital signs
17.1.4. monitor intake and output
17.1.5. IV solutions should be administered at slower rate
17.1.6. Isotonic saline is preferable and glucose containing solutions are not recommended
17.1.7. osmotic diuretic , inotropic and vasopressor medications prescribed
17.1.8. blood products replacement
17.2. maintain ABG
17.2.1. maintain a patent airway by insert OPA or suction
17.2.2. Administer oxygen therapy or M,V then adjust PaO2 at 100mmHg and PaCO2 at 30-35mmHg
17.2.3. correct anemia
17.2.4. prevent aspiration and DVT
17.2.5. Normoglycemia
17.2.5.1. reduce solutions contain dextrose
17.2.5.2. monitor glucose frequently
17.2.5.3. administer insulin according to need
17.3. Decrease metabolic demands
17.3.1. monitor temperature- WBCs- cultures
17.3.2. maintain normothermia
17.3.3. prevent shivering
17.3.4. prevent and early detect infection
17.3.5. seizure prevention or control
17.3.6. pain management
17.4. promote venous drainage to prevent increase ICP
17.4.1. monitor s&s of increased ICP
17.4.2. positioning
17.4.2.1. head of bed elevated 30 degree
17.4.2.2. avoid activities increase ICP
17.4.2.3. never place pt at head low position
17.4.2.4. maintain head at neutral position
17.4.2.5. avoid flexion or twisting of neck or hip
17.4.2.6. change position/2hrs
17.4.2.7. when moving conscious patient tell him not to push with feet
17.4.3. care of ETT or TT
17.4.4. maintain cervical immobilization by neck collar
17.4.5. prevent valsalva maneuvars ( sneezing- coughing- staining)
17.4.5.1. use laxatives
17.4.5.2. eat fibers food
17.4.6. avoid use of enemas
17.4.7. NGT drainage
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
19.1.3.1. check response
19.1.3.2. observe chest movement or auscult breathing sound over 10sec
19.1.4. assess indicators of airway obstruction
19.1.4.1. tachypnea or apnea
19.1.4.2. use of accessory muscle
19.1.4.3. increase respiratory effort
19.1.4.4. intercostal retraction
19.1.4.5. noisy respiration
19.1.4.6. central cyanosis or pallor
19.1.5. if airway is compromised
19.1.5.1. perform jaw thrust
19.1.5.2. insert ETT if GCS 8 or less but avoid nasal
19.1.5.3. suction
19.1.5.4. insert orogastric tube to decompress stomach to prevent abdominal pressure thus decrease ICP
19.1.5.5. cover wound if present
19.1.5.6. assist on needle thoracotomy or ICT insertion
19.1.5.7. Administer humidified o2 ot MV
19.2. Circulation
19.2.1. Assessment of
19.2.1.1. pulse rate and rhythm
19.2.1.2. bleeding
19.2.1.3. skin color and temperature
19.2.1.4. capillary refill
19.2.1.5. 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