Head And Facial Trauma Flashcards
Is spinal precaution required in Maxillofacial injuries?
Yes as they are associated with high percentage of cervical spine injuries
S&S Maxillofacial Injury
> Asymmetry of cheek bone prominences > Crepitus > Dental Malocclusion > Displacement of nasal septum > Lacerations and Bleeding > limitation of forward movement of mandible > Limited ocular movement > Numbness > Pain > Swelling > Visual Disturbances
Commonly seen mechanisms of injury to Anterior Neck?
> Stangulation Injuries > Blows to neck > Contact Sports > Hangings > Horse back riding > Hyperextension and hyperflexion injuries > Industrial injuries > Missile injuries from firearms > MVA > Stab wounds > Violent Altercations > Water Sports
Why are injuries to the anterior neck a concern?
> Airway Obstruction
Oedema
Massive Haemorrhage
Oesophageal Rupture
4 Type of Skull Fracture
- Linear - a thin line or crack
- Open - where the brain is exposed to the outside environment
- Depressed - one of more fragments of bone has been pushed inwards and is pressing against the brain
- Basilar - a fracture at the base of the skull associated with high mortality
S&S of Basilar Fracture (4)
- Blood behind the tympanic membrane caused by fractures of the temporal bone
- CSF leakage - often leading o infection
- Battle signs - ecchymosis over mastoid process resulting from fracture to the temporal bone (late sign)
- Raccoon Eyes - ecchymosis of one or both orbits caused by fracture of the base of the sphenoid sinus (late sign)
Munro-Kellie Doctrine and why is it important?
- Skull is a closed box with a nearly incompressible brain
- 3 contents: Brain, CSF, Blood
- Any increase in size of ICP the body with compensate and CSF ⬇️ and Blood ⬇️
- If that’s is not sufficient the brain will start to move through the foramin Magnum resulting in Herniation.
If injured brain becomes hypoxia, what is effect of cerebral flow?
> CO2 ⬆️ in cerebral blood supply = acidotic environmnet
Carbon dioxide is a primary driver for vasodilation, so therefore blood vessels within the injured brain with vasodilate in attempt to ⬆️ blood flow
If a pt is over-ventilated what is the effect of the cerebral blood flow?
If excessive amount of oxygen is supplied then CO2 will be decreased = vessels to vasoconstrict = reducing amount of circulation to the brain = hypoxia
Describe Primary and Secondary Brain Injury
Primary: direct and indirect forces on brain which causes an immediate and irreversible insult.
Secondary: hours or days after after primary insult, can be limited by appropriate management. Caused by intracranial or systemic effects (oedema, mass lesions, or direct neuronal damage)
Differentiate between mild diffuse, mod diffuse and disuse axonal injury?
Mild Diffuse: CONCUSSION, NO PERM BRAIN INJURY
Mod Diffuse: pt will have some form of mild neurological impairment
Diffuse Axonal: shearing, tearing, stretching of nerve fibres within the brain
3 main issue cause increased intracranial pressure?
- Oedema
- Ischemia
- haemorrhage
⬆️ ICP S&S
Cushions Triad: ⬆️ BP ⬇️ RR/irregular ⬇️ HR ⬇️ conscious state Decrebrate / Decorticate posturing Unequal/⬇️ pupil reaction
Management of Head injury?
A- airway adjuncts/advanced airway management
Consider C-Spine until proven otherwise
Double airway manouver
Prophylactic IV/IM Ondansatron
B- Ventilation if required at 7-8 breaths/min (as hyperventilation can cause secondary brain injury through vasoconstriction ⬇️ cerebral flow
02 100% to maintain O2 >90%
C- Control any major Haemorrhage
IV Access/IVF KVO if pt normotensive/hypertensive otherwise Tritate to maintain BP SYST >90mmHg (pts usually hypertensive if hypo look for bleed in other area)
D- Maintain BSL >4mmol/L (GLUCOGON or IV Glucose) to ensure adequate glucose for brain
Montior Consious state closely as this can determine a rise in ICP
E- Look for other evidence of haemorrhage in long bones chest abdomen and pelvis. Protect from hypothermia. Raise head 30 degrees if able to assist with venous drainage.
