Head injury .

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Head injury . by Mind Map: Head injury .

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