1. RTA - Sport injuries - Fall
1.1. Traumatic brain injuries
1.1.1. Types
1.1.1.1. A) Primary
1.1.1.1.1. Diffuse
1.1.1.1.2. Focal
1.1.1.2. B) Secondary
1.1.1.2.1. 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
14.2.5.1. reduce solutions contain dextrose
14.2.5.2. monitor glucose frequently
14.2.5.3. 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
14.4.2.1. head of bed elevated 30 degree
14.4.2.2. avoid activities increase ICP
14.4.2.3. never place pt at head low position
14.4.2.4. maintain head at neutral position
14.4.2.5. avoid flexion or twisting of neck or hip
14.4.2.6. change position/2hrs
14.4.2.7. 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)
14.4.5.1. use laxatives
14.4.5.2. 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
16.1.1.1. 1- immobilization.
16.1.1.2. 2- palpate for skull trauma.
16.1.1.3. 3- Apply indirect pressure to stop bleeding and avoid pressure at depressed area.
16.1.1.4. 4- Manage hypovolemia.
16.1.1.5. 5- Cleansing and debridement of wound.
17. Fracture at skull bone
17.1. Skull Fracture
17.1.1. types
17.1.1.1. 1- linear or simple.
17.1.1.1.1. The bone isn't displaced.
17.1.1.1.2. Don't need special care.
17.1.1.2. 2- Depressed.
17.1.1.2.1. depression of bone.
17.1.1.2.2. Common on children ( softer skull ).
17.1.1.2.3. if depression more than 5mm needs surgical elevation to prevent infection and brain contusion.
17.1.1.2.4. Management
17.1.1.3. 3- Base of skull.
17.1.1.3.1. Signs and symptoms:
17.1.1.3.2. 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
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