EMER 113/114 Trauma Flashcards
The following factors also contribute to serious injury on the farm
Very few safety regulations exist When a farmer becomes entangled in equipment, lengthy extrications are often required, which aggravates and increases the severity of injury. Since many farmers work alone in remote areas, they may not be missed for hours. Long transport times contribute to the severity of injuries
Pinch points
two objects meet to cause a pinching or pulling action. Example: Chain driven parts
Wrap points
an aggressive component of machinery moves in a circular motion. Example: Power take off
Shear points
two objects move close enough together to cause a cutting action. Example: Auger
Crush points:
two large objects come together to cause a crushing action. Example: Feed roller
Stored energy
hazards remain after the machinery is shut down. Example: Spring loaded equipment
Once the vehicle has been stabilized, it may be shut down using the following procedures:
Enter the cab or climb onto the operator’s platform. Locate the ignition switch or the key and throttleSlow the engine down with the throttle and then switch or turn off the key or ignition. If you cannot shut down the engine from the cab or operator’s platform, try the shut-off valve at the bottom of the fuel tank. If this does not work, try clamping the fuel line (rubber or metal hose) with a pair of pliers or vice-grips. If the patient is in a life-threatening situation and all other attempts to shut down the engine have failed, discharge a CO2 fire extinguisher into the air intake.
Power Takeoff Shafts (PTO)
is a specially designed shaft that connects the tractor’s engine to other agricultural implements such as augers, mowers, and corn pickers. PTO–related accidents occur when clothing gets caught in the spinning shaft and pulls the worker in. Arms and legs may be amputated. The worker’s body may also be wrapped around the shaft.
Combines
A common source of injury is the auger. The auger is the rotating part of a screw conveyor. It can pull in victims with extreme force, often causing complete amputations of extremities. Other sources of injury are the heads, which have oscillating cutting bars; reels with hardened steel tines that can impale the patient; and snapping rollers, which cause severe crush injuries. Never use the self-reversing feature on a combine to remove a trapped patient.
Hay Balers
A worker can be picked up and pulled into the header assembly. He can be entrapped up to the shoulders, and the tines can cause penetrating wounds in the chest and abdomen. Avulsions of various degrees can be caused by the cross auger.
grain bins
Usually loaded by augers, grain bins come in a variety of sizes. Workers who enter one to get grain flowing can be buried with grain in seconds. Because most bins unload from the centre, most patients are found in the middle of the bin. The temperature of stored grains is low, even in the summer. The patient could become hypothermic, possibly prolonging survival.
General guidelines for grain bin extrication include the following:
Keep fans working until the actual extrication begins—this may provide more air to the patient. Ensure the fire department is on-scene with a charged water line. Cut two 18-inch triangles in the side of the wall on opposite sides of the bin. The holes should be as high as possible, but remain below the grain level. Open the holes at the same time to allow the grain to flow out of the bin evenly. You may have to cut additional holes as the grain level drops. Once you have exposed the patient, secure him with a lifeline. Try to shore the grain away from the patient. You could use spine boards, plywood, metal sheets, etc Remove as much grain from around the patient as possible before extrication. Pulling against the force of the grain can cause further injury. Airway management and spinal immobilization are management priorities.
Silos
used to store chopped grain or hay as feed for livestock. They may be constructed of clay blocks, concrete blocks, steel sheets, poured concrete, or steel glass-lined sheets. When crops are stored in silos, gases are formed by natural chemical fermentation. Fermenting crops can release high levels of carbon monoxide, methane, and oxides of nitrogen (“silo gas”).
silo gas
Red-brown to yellow-green in colour, silo gas smells like household bleach and will kill within minutes in high concentrations. Because silo gas is heavier than air, it flows down the side chute and out the open silo door. People working around the base of the silo, in the feed room, or adjacent barn can be exposed to dangerous levels of silo gas. Low levels of silo gas can irritate the nose, throat, and lower airway.
The presence of silo gas may be recognized by the following signs:
Bleach-like odour Yellowish or reddish vapour hovering over the product Stains of red, yellow, or brown on the product or other surfaces contacted by the gas Dead birds or insects near the silo Nearby livestock with signs of illness
When rescuing a patient exposed to silo gas, follow these guidelines:
All rescuers entering the silo or contaminated structures must use a self-contained breathing apparatus (SCBA) and appropriate protective clothing and eyewear. All rescuers coming into contact with the patient must use appropriate protective clothing, eyewear, and gloves Follow decontamination procedures. All patients must be transported to a health care facility.
Manure Storage There are two potential injuries from liquid manure
drowning and inhaling toxic fumes. The liquid manure releases ammonia, carbon monoxide, carbon dioxide, methane, and hydrogen sulfide. Agitation of the manure pit can cause the sudden release of hydrogen sulfide.
Signs and symptoms of hydrogen sulfide intoxication
cough, irritation of mucus membranes, nauseapulmonary edema. High concentrations can cause respiratory paralysis respiratory arrest and sudden collapse.
Agricultural Chemicals
Poisoning from these agents are often overlooked because the signs and symptoms resemble other common medical conditions including heat exhaustion, food poisoning, asthma, allergies, congestive heart failure, smoke inhalation, and influenza to name a few.
Rescue
needs to deliver for danger or imprisonment’
Technical rescue incident
complex rescue incident involving vehicle extrication, rescue from water, ice or confined spaces, rescuing following trench, structural collapse, high angle rescue, response to hazardous materials incident wilderness search and rescue in specifically trained personnel in special equipment
Three levels of training and technical rescue
Awareness: emphasis on recognizing the hazards, securing the scene and calling for appropriate assistance Operations: operations training will allow you to assist directly into the rescue operation and take a limited part in rescue incidents Technician: directly involved in the rescue operation itself
Steps of Special Rescue
Preparation Response Arrival and assessment Stabilization Access Disentanglement Removal Transport
Preparation
Does the service have the personnel and equipment needed to handle a TRI from start to finish Which equipment and personnel will be first on scene what resources will be available on call Do members of the service know the hazards in the response area
Response
A dispatch protocol should be established Respond with resources including a rescue squad, a fire engine, fire supervisory staff, an ambulance and a paramedic supervisor Might need to notify utility companies
Arrival and assessment
Immediately on arrival incident commander will assume command A rapid an accurate seen assessment is needed to see what additional resources might be needed and to determine danger Assess the extent of injuries and number of patients
Stabilization
Establish an outer perimeter to keep public and media out of staging area and maintain a smaller perimeter directly around the rescue The size of the rescue area is proportional to the hazards are exist
Hot zone
Area for entry teams and rescue teams this zone immediately surrounds the site of incident
Warm zone
the warm zone is only for properly trained and equipped personnel this is where personnel and equipment decontamination and hot zone support take place
Cold zone
outer perimeter in which vehicles and equipment are staged and the command post is located
Access
Gain access to the patient how is he or she trapped Identify the actual reason for the rescue and work toward freeing the patient safely Communicate with patients at all times during the rescue to make sure they are not injured further by the rescue operation
Disentanglement
involves free and patient from area or object in which they are trapped Unless there’s an immediate threat you should perform an initial assessment and any necessary interventions before disentanglement such as intravenous, spinal motion restriction, securing the airway, administering oxygen, providing ventilation or controlling significant bleeding
Removal
What’s the patient has been disentangled and life hazards treated begin removing patient Quick removal may occur if hazards are present such as spilled gas or other materials that could endanger patient or rescue personnel The only time the patient should be moved prior to completion of initial care, assessment, stabilization and treatment is when the patients or emergency responders life is in immediate danger
Scene assessment begins with info from dispatch and bystanders Information collected should include the following:
Location of incident Nature of incident Number of patients trapped or injured Condition and position of patients Nature and estimated severity of specific injuries Condition and position of vehicles Hazards at the scene or specific hazard information Name of person calling in a number where person can be reached Identify in life-threatening hazards, take corrective measures to mitigate them determine whether situation is a search, rescue or recovery
A scene assessment should include the initial ongoing evaluation of the following issues:
Scope and magnitude of the incident Risk and benefit analysis Potential number and severity of patients Hazards Access an exit from the scene Environmental factors Available and necessary resources Publishment of a control perimeter
Outer circle survey
involves evaluating the area surrounding the technical rescue incident Identifies any life threatening hazards and taking measures to avoid or mitigate them
Inner circle survey
might help responders notice downed wires on top of a behicle or additional victims beneath it
Incident command
First arriving officer
Utility hazards
Can be above ground and below ground Park 15m away from downed power lines
Motor Vehicle Collisions
Parker emergency vehicles in a manner that will ensure safety and not distract trafficked On limited access highways keep vehicles in apparatus not directly involved in the rescue off the roadway Use only essential warning lights and do not assume that motorist will heed them Energy absorbing bumpers can explode when subjected to heat and can spring out when loaded Airbags can deploy at any time after collision and must be deactivated even if the power supply to the vehicle has been disconnected Conventional fuel systems with highly flammable vapours may ignite if they come in contact with hot converters or heated engine components
The A postThe B postsThe C postsThe D posts
The A posts are located closest to the front of the vehicle they form the sides of the windshield The B posts in four-door vehicles are located between the front and the rear doors of a vehicle The C posts in four-door vehicles if present or located behind the rear doors The D posts can be found on large vehicles such as sport utility vehicles and vans that have windows behind the rear doors
Platform frame construction on vehicles
uses beams to fabricate the loadbearing frame of a vehicle found primarily in trucks and SUVs Provides a structurally sound base for stabilizing the vehicle and an anchor point for attaching cables or extrication tools
Unibody construction on vehicles
is used for the most modern cars combines the vehicle body in the frame into a single component Allows auto manufacturers to produce light weight vehicles When Extricating a person from such a vehicle remember that unibody vehicles do not have the frame rails that are present in platform frame constructed vehicles
Alternative Power Vehicles
Encompass vehicles powered by electricity, gas, ethanol, bio diesel fuels and other less common alternative power sources
Electric and hybrid power
Electric vehicles are powered by hydrogen fuel cells all electric batteries are a combination of gasoline and electric power most common types of alternative power vehicles rescuers are likely to encounter The less commonly encountered but more hazardous is leakage of chemicals from damaged battery packs releasing toxic gels liquids or gases
Liquified petroleum Gas (LPG)
similar to traditionally fuel vehicles but use compressed propane gas or a mixture of propane and butane sometimes referred to as auto gas Hazard after a crash if large amounts of highly flammable or reactive gases leak from vehicle
Ethanol and flex fuel
vehicles powered by ethanol and flex fuel are almost identical to traditional gasoline powered vehicles in appearance and operation
Biodiesel and dimethyl ether
almost identical to traditional diesel counterparts in appearance in operation
Fire fuelled by ethanol or methanol
burns bright blue and gives off a little to no smoke hard to see during clear day
Tips for managing alternative power vehicle hazards
Look for marking specific to alternative power vehicles and call early for assistance Do not use flares to mark off the incident scene is nonsparking markers Stabilize the vehicle by engaging the break setting the parking brake putting the transmission in park turning off the ignition and stabilizing the scene applicable Quiet hybrid or electric vehicle is not necessarily turn off or power down Be aware of the possibility of toxic vapours gases and fumes even if no fires present Avoid contact with any fluids leaking from the vehicle Call for hazardous materials team
Cribbing
short lengths of timber used to stabilize a vehicle prevents it from moving
Step blocks
stairstep shaped blocks that are placed under the side of the vehicle
Wedges
used to snug loose cribbing under the load or when using lift airbags to fill the void between the crib and the object as it is raised
Confined space
a structure that is not designed for continuous occupancy and that usually has limited openings for entry and exit Ventilation may be too limited to provide adequate air circulation and exchange Inadequate ventilation may trap flammable mixtures, presenting the risk of fire and explosion
Hydrogen sulphide
is a colourless, toxic, flammable gas released by bacteria break down organic matter in the absence of oxygen Can be found in swamps Heavier than air and has a pungent odour at first but quickly deadens a person’s sense of smell
Carbon monoxide
is a colourless, odorless, tasteless gas that cannot be detected by a persons senses Inhaling this can cause severe poisoning because the CO binds to hemoglobin in red blood cells preventing oxygen from binding
Carbon monoxide signs and symptoms
headache, nausea, disorientations and unresponsiveness
Carbon dioxide
colourless gas associated with asphyxiation End product of metabolism Produces sour taste in mouth and a stinging sensation in nose and mouth
Methane
the principal component of natural gas Not toxic but will cause burns if ignited Used as a fuel from natural gas but can be generated from fermentation of organic matter
Ammonia
is a toxic, corrosive chemical with a characteristic pungent odour Lighter than air and rises to top of any confined space
Nitrogen dioxidered-
red-brown gas that has a characteristic sharp, biting odour
Water Self rescue position
roll faceup, arched position, lower back higher than feet
cold water incidents
Water causes heat loss at a rate 25 times greater than ambient air temperature In extremely cold water 4 degrees a person is likely to die after 15-20mins
Heat escaping lessening position
draw knees close to the chest, pressing the arms close to the sides of the body and keeping the head and neck out of the water
Cold protective response
when the body is submerged in cold water heat is conducted from body to water resulting in hypothermia which can protect vital organs from lack of oxygen
Reach, throw, row, go
Reach: first attempt to reach out using any object Throw: if you cannot reach the person throw something Row: if you cant reach by throwing row out to person Go: last resort go into water only if safe for you
Spinal incidents in submersion incidents Assume spinal injury exists with the following conditions:
Submersion has resulted from a diving mishap or fall The patient is unresponsive and no info is available to rule out c spine injury Patient is responsive but reports weakness, paralysis or numbness in the arms or legs You suspect the possibility of spinal injury despite what witnesses say
rope rescueLow angle operations
situations where the slope of the ground over which the rescuers are working is less than 45 degrees Rescuers depend on the ground for their primary support and the rope as a secondary support Used when ropes are needed to haul up a patient or rescuer
Belay
is a technique of controlling the rope as it fed out to the climbers to protect them in the event of a fall
Scrambling
a method used to ascend rocky face and ridges can be described as a cross between hill climbing and rock climbing
Hasty rope slide
self escape procedure when there is no other means of egress
rope rescueHigh angle operations
situations in which the slope of the ground is greater than a 45 angle and rescuer or patients are dependent on a life safety rope and not a fixed surface of support such as the ground
Critical infrastructure:
electrical power grid, communications system, fuel for vehicles, water, sewage removal, food, hospitals and transportation systems
Open incident
has a number of candidates not found yet when you answer the initial call
Closed incident
contained incident in which patients are found in one location and the situation is not expected to produce more patients
Freelancing
in which individual units or different organizations make independent and often insufficient decisions about the next appropriate action
Span of control
the number of resources for which a supervisor is responsible usually expressed as a ratio of supervisors to responders the optimal span of control is 1: 5 to you maintain effective communication limit the number of subordinates to 3 to 7
ICS Roles and Responsibilities
At minimum the command staff include someone in charge known as the incident commander In larger incidents as a position such a safety officer in public information officer’s are included The general staff includes operation, planning, logistics and finance/administration sections
Incident commander
is the person in charge of the overall incident
command staff
safety officerpublic information officerliaison officer
Safety officer
monitors the scene for conditions or operations that may be present a hazard to responders and patients
Public information officer:
provides the public and media was clear and understandable information ‘Positioned well away from incident command post
Liaison officer
relays information and concerns among command, the general staff and other agencies
Unified command system:
plans are drawn up in advance by all cooperating agencies that assume a shared responsibility for decision-making and cooperation
Single command system
one person in charge and is generally used with small incidents that involve only one responding agency
Operations section and chief
Responsible for managing the tactical operations job usually handled by the incident commander on routine calls Operation section chief: supervise the people working at the scene of the incident who will be assigned to branches divisions in groups
Planning section
Solves problems as they arise during the MCI Planners obtain data about the problem analyze the previous incident plan and predict what or who is needed to make the new plan work Buyers need to work closely with operations, finance and logistics
Logistics
Responsible for communications equipment, facilities, food and water, fuel, lighting and medical equipment and supplies for patient emergency responders
Finance
Responsible for documenting all expenditures at an incident for tracking and reimbursement
Medical incident command
Incidents that have a significant medical factor the IC should appoint someone to be leader this person will supervise the primary roles of the medical group triage, treatment and transport
Triage officer
ultimately in charge of counting and prioritizing patients the primary duty is to ensure that every patient receives initial assessment of her condition one of the most difficult parts of being a triage officers that you may not begin standard treatment until all patients are triaged
Treatment officer
locate and set up the treatment area with a tear for each priority of patient they ensure that secondary triage patient is performed in that adequate prehospital care is given Have a responsibility to assist with moving patients to the transportation area
Transportation officer:
Coordinates of transportation and distribution of patients to appropriate receiving hospitals he role of the transportation officers to communicate with the area hospitals to determine where to transport patients Documents attracts the member of vehicles transporting, patient transported and the facility Destiination of each vehicle and patient
Staging officer
should be assigned when MCI’s or scenes require response by numerous emergency vehicles or agencies Staging area should be established away from the scene because the parked vehicles can be in the way
Physicians on scene
Provide secondary triage decisions in treatment sector deciding which patients are to be transported first On scene medical direction
Triage
Means to sort patients based on severity of their injuries and prioritize them for care
Primary triage
the initial triage done in the prehospital environment Briefly assessed and identified in someway such as a triage tag
Secondary triage
done as patients are brought to the treatment area
After the primary triage the team leader should communicate the following information to the medical group leader:
The total number of patients The number of patients in each of the triage categories Recommendations for extrication and movement of patients to the treatment area Resources needed to complete triage and begin movement of patients
Triage categories
Immediate red tags: problems with ABCs, head trauma or signs of shock Delayed yellow: patients are second priority and will need treatment and transport but it can be delayed multiple injuries to bones or joints Minimal green tag: third priority patients may require no prehospital or minimal treatment Expectant Black tag: patients who are dead or who’s injuries are so severe that they have at best a minimal chance of survival
START Triage
perform arrival at scene calling out if you can hear my voice and are able to walk then direct patient Move to the first non-ambulatory patient and assess respiratory status Assess hemodynamic status: check for radial pulse Assess the patient’s neurological status if they can follow commands is yellow if no red
START Triage resp status
if the patient is not breathing you should open the airway by using a simple maneuver a patient who still does not begin to breathe is triaged as black if the patient begins to breathe tag them as red If the patient is breathing a quick estimation of respirate should be made a patient who is breathing faster than 30 breathes/min is triaged as red if the patient is breathing fewer than 30 move to the next step
START triage hemodynamic status
Absent radial pulse implies hypotension and should be triaged as read Radio pulses present go to the next assessment
jumpSTART triage for pediatric patients
Intended for children younger than eight years or who appear to weight less than 45kg Identify the walking wounded asses resp statuspulse check Check for Distal pulse if there is an absence of a distal pulses label as red mental status
jumpSTART triage for pediatric patients Respiratory status
If not breathing immediately check pulse if no pulse label Black It’s not breathing but has a pulse open the airway with a manual maneuver if the patient does not begin to breathe café rescue breaths and check respirations again Child who does not begin to breathe should be labelled expectant Breathing less than 15 breaths per minute or more than 45 breaths per minute is tagged as red
jumpSTART triage for pediatric patients mental status
A child who is unresponsive or response to pain by posturing or within incomprehensible sounds or unable to localized pain is red A child who responds to pain by localizing in a withdrawing from it is yellow
SALT Triage
Sort assess lifesaving interventions and treatment Identify the patients who are ambulatory Allows for limited rapid interventions including bleeding control, open the airway, needle decompression and auto injector
meninges
Fibrous coverings of the brainDura mater, arachnoid mater and pia mater
The intercranial volume is composed of
the brain, the CSF blood in the blood vessels which completely fill the cranial cavity Any increase in one of the components is at the expense of the other two
Monro-kellie doctrine
because of the fix space within the rigid skull as a brain tissue swells it takes up more volume initially with brain swelling, blood and CSF volumes inside the skull decrease and compensate for the rise and pressure as brain swelling continues compensation fails and intercranial pressure begins to rise As the ICP increases the amount of blood they can enter the skull and perfused brain decreases leading to further brain injury
what happens when something obstructing the outflow a spinal fluid
Trumatic blood in the vesicles or subarachnoid space will cause an accumulation of spinal fluid within the brain and an increase in ICP
Primary brain injury
is the immediate damage to the brain tissue that is direct result of the mechanical force and is essentially fixed at the time of injury Most primary brain injuries occur either as a result of external force is applied against the skull or from movement of the brain inside the skull
deceleration head injuries
the head usually strikes in object which causes a sudden discolouration of the skull the brain continues to move forward impacting first against the skull in the original direction of the motion third collision and then rebounding to hit the opposite side of the inner surface of the skull a fourth collision
Coupcontracoup
Coup: injuries that occur to the brain in the area of the original impact Contracoup: injuries that occur to the brain on the opposite side
Secondary brain injury
is the result of hypoxia and or decreased perfusion of the brain tissue In response to the primary insult swelling can cause a decrease in perfusion result in Vasodilation with increased blood flow to the injured area No extra space inside the skull swelling of the injured area or newly formed intracerebral haematoma increases intracerebral pressure leading to a decrease cerebral blood flow that causes secondary brain injury
hypoventilation vs hyperventilation
An increase in the level of CO2 hypoventilation promotes vasodilation of vessel supplying the brain whereas lowering the level of CO2 hyperventilation causes vasoconstriction and decreases blood flow to the brain
Intracranial pressure
The pressure within the skull
increased ICP
Blood supply will be decreased by the increased ICP and because the brain requires a constant supply of blood to survive brain swelling can be rapidly catastrophic ICP is considered dangerous when it rises above 15 mmHg cerebral herniation may occur at pressures above 25 mmHg
Cerebral perfusion pressure (CPP):
The net pressure gradient causing blood flow through the brain It’s value is obtained by subtracting the ICP from the MAP
what happens when ICP increases
the system blood pressure increases to try to preserve blood flow to the brain the body senses the rising systemic blood pressure and this triggers a drop in pulse rate
why does heart rate drop when ICP increases
the body tries to lower the systemic blood pressure by lowering cardiac output
Cerebral perfusion
Pressure required to perfuse brain You must maintain a CPP of 60 to 70 mmHg which requires maintaining a map of greater than 70 mmHg in the patient with severe TBI CPP= MAP-ICP Map constant + ICP increase = CPP Decrease Map increases + ICP constant = CPP Increase MAP decrease + ICP increase =CPP critical
map in normal brain vs ICP brain
Map- normal brain 65+= 90/p Map- increase ICP = 85 110/p
Cerebral Herniation Syndrome
When the brain swelling or intercranial haemorrhage occurs particularly after a blow to the head a sudden rise in ICP may occur and force portions of the brain downward through the tentorium cerebelli This leads to obstruction of the flow of CSF in the herniated brain apply significant pressure to the brain stem resulting in cerebral herniation syndrome
Cerebral Herniation Syndrome signs and symptoms
a decreasing LOC that rapidly progresses to comadilation of the pupils in an outward downward deviation of the eye on the side of injury paralysis of the arm and leg on the side opposite the injury or dcerebrate positioning, vital signs revealed increased blood pressure and bradycardia
signs of Increasing ICP
Respirations- increase, decrease, irregular Pulse- decrease Blood pressure- increase, widening pulse
Cushings reflex
increase BPdecrease heart rateirregular resp: Heyne stroke
Hyperventilation
Hyperventilation will decrease the size of the blood vessels in the brain and briefly decrease ICP Cerebral herniation syndrome is the only situation in which hyperventilation is still indicated you must ventilate every three seconds and attempt to keep ET CO2 at 30 to 35 mmHg
When to hyperventilate:
after fixing hypoxia and hypotension1. TBI patient with a GCS score less than 9 with extensor posturing (decerebrate) 2. TBI patient with a GCS score less than 9 with asymmetric, dilated, or non-reactive pupils –Remember hypoxemia, orbital trauma, substances, lightning strike, and hypothermia also affect people every reaction 3. TBI patient with an initial GCS score less than 9 that then drops his or her GCS by more than two points
treatment of facial injuries
gentle irrigation with normal Celine if needed an application of Eyeshield Elevate the head of a stretcher if possible
open skull fracture treatment
Open skull fracture should have the wound dressed but avoid excess pressure when controlling bleeding penetrating objects in the skull should be secured patient transported immediately
Concussion
There is a history of trauma to the head with a variable period of unconsciousness or confusion and then a return to normal consciousness There may be amnesia following the injury which usually extends to some point before the injury rendering the patient unable to remember events leading up Patient may report dizxiness, heacdache, ringing in the ears, or nausea
Cerebral contusion
A patient with a cerebral contusion bruised brain tissue will usually have a history of prolonged and consciousness or serious alteration in LOC The patient may have focal neurologic signs and appear to have suffered a cerebrovascular accident May have personality changes
Diffuse axonal injury
Result of severe blunt head trauma Generalized edema The patient presents unconscious, due to disruption of nerve fibers between the cortex and brain stem with no focal motor deficits
Anoxic brain injury
Perfusion of the cortex is interrupted due to spasm that develops in the small cerebral arteries after 4 to 6 minutes of anoxia restoring oxygenation and blood pressure will not restore perfusion of the cortex and they will be irreversible damage Hypothermia seems to protect against this phenomenon
Intracranial hemorrhage
hemmorhage can occur between: the skull in the Dura, between the Dura and the arachnoid, beneath the subarachnoid or directly in the brain tissue
Acute epidural haematoma
bleeding between dura mater and skullBecause the bleeding is usually arterial bleeding and rise in ICP can occur rapidly and death may occur quickly
symptoms of Acute epidural haematoma
a history of head trauma with initial LOC, often followed by a lucid periodA few minutes to several hours the patient will develop signs of increasing ICP Lapse into unconsciousness, and develop body paralysis on the side opposite the head injury pupils Often dilated and fixed people on the side of the head injury
Acute subdural hematoma
bleeding between dura and arachnoid layers ICP increases slowly and the diagnosis is often not apparent until hours or days after injury Use of anticoagulants increases the risk of subdural bleeding Those with alcoholism and older adults are at high risk for this injury after a deceleration injury
Acute subdural hematoma signs and symptoms
headache, fluctuations in LOC, focal neurological signs
Subarachnoid hemorrhage
bleeding between brain and subarachnoid layerRarely occurs alone most commonly associated with subdural haematoma or cerebral contusion The massive amount of subarachnoid blood causes irritation that result in intravascular fluid leaking into the brain causing more Edema
signs and symptoms of subarachnoid hemorrhage
headache, coma, and vomiting
intracranial pressure
Is bleeding within the brain tissue that may result from blunt or penetrating injury so the head
signs and symptoms of intracranial pressure
depend on the regions involved in the degree of the injury They occur in anatomical pattern similar to those from a stroke in the same area of the brain alteration in LOC is commonly seen Awake patient complains of headache and vomiting
A basilar skull facture may indicate any of the following
bleeding from the ear or nose, clear fluid from nose or ear, battle signs and raccoon eyes
pupils
are controlled by the third cranial nerve which is affected by the increasing ICP if both pupils are dilated and do not react to light the patient probably has a brainstem injury if pupils are dilated but still reactive to light the injury is often reversible a uni laterally dilated pupil remains reactive to light may be the earliest sign of cerebral herniation the development of a unilaterally dilated nonreactive pupil (blown pupil) is an extreme emergency and requires hyperventilation
