Head & facial Trauma Flashcards
What is emesis?
Vomiting
Describe management principals of maxillofacial injuries
Spinal precautions
Keep airway clear (teeth, vomit, blood)
Consider airway adjuncts
Control bleeding
What is a medication for epistaxis?
Cophenylcaine
Name 5 ear injuries
Lacerations and contusions Thermal injury Chemical injury Traumatic perforations Barotitis (injury from pressurisation)
Name 4 eye injuries
Foreign bodies
Blunt eye injuries
Penetrating eye injuries
Chemical injuries
What medication used for eye injuries (and spinal)?
Ondansatron
Name 5 types of anterior neck injury
Haematoma or oedema Lacerations & punctures Vascular injury Laryngeal/tracheal injury Oesophageal injury
2 types of TBI
Primary injury: occurs at time of impact. Irreversible
Secondary injury: occurs minutes or days after primary injury and worsens outcome. A result of hypoxia, seizure or oedema.
Name 4 types of skull fracture
Open
Linear
Depressed
Basilar
Describe mild diffuse brain injury
Transient alteration in neurological function.
No abnormality in CT scan
May have: headache, retrograde or anterograde amnesia, confusion, dizziness, nausea and vomiting.
Resolves spontaneously without defect.
Describe Axonal Injury
Shearing and stretching of nerve fibres leading to diffuse brain injury.
Occurs with acceleration deceleration MOI
Describe Focal Injury
Specific, grossly observable brain lesions
Bleeding, contusions, oedema, haemorrhage
Bleeding often resulting from skull fracture
Name 4 types of intracranial haematomas
Epidural
Subdural
Subarachnoid
Intra cerebral
What is the Monro-Kellie Doctrine?
The total intracranial volume is fixed because of the inelastic nature of the skull.
Volume is filled by the brain, blood and CSF, if injury occurs and occupies space some other structure needs to be forced out.
Volume of blood and CSF is reduced, if this isn’t sufficient the brain will be forced out of the foramen magnum.
Describe Focal Injury- Contusions
Bruising of the brain tissue at level of cortex or deeper within lobes.
Greater neurological deficits and abnormalities.
Describe Epidural Haematoma
It is a rare focal injury.
Arterial bleeding between cranium and dura.
Signs: raised ICP, headache, lethargy.
Describe Subdural Haematoma
A Focal injury resulting from blunt trauma.
Generally venous bleed so slower progression than epidural bleed.
Signs: headache, lethargy, nausea, vomiting, posturing and paralysis.
Describe Subarachnoid Haemorrhage
It is a Focal head injury with bleeding into subarachnoid space.
Common finding in TBI patients.
Results from tearing of small pia vessels.
Signs: sudden severe headache, photophobia (light hurts head) vomit
Describe Intracerebral Haematoma
Bleeding anywhere within brain.
Can be caused by either blunt or penetrating trauma.
What is the Cushing’s Triad?
Increased BP
Irregular breathing
Decreased HR
It is a physiological nervous system response to ICP.
What is Cheyne-Stokes breathing?
Unusual pattern of breathing.
Characterised by deeper faster breathing, followed by gradual decrease, resulting in apnoea.
Name 3 types of ICP
Mild elevation
Moderate elevation
Marked elevation
Signs of mild elevation ICP
Increased BP
Normal pupils
Cheyne-Stoke respirations
Patient attempts to localise and remove from painful stimuli
Signs of Moderate Elevated ICP
Widened pulse pressure and bradycardia
Pupils sluggish or non reactive
Central neurogenic hyperventilation
Decerebrate posturing
Signs of Marked elevation ICP
Fixed and dilated pupils
Ataxic or absent respirations
Flaccid paralysis
Irregular pulse rate
What is the Cerebral Perfusion Pressure (CPP) formula?
CPP= MAP-ICP
When one goes up the other goes up also
What is management for TBI
Aim to prevent secondary injury
All patients have c-spine injury until proven otherwise
Ondansatron must be administered
LOC most important assessment
Continual reassessment compared with initial examination vital
What is the key head injury management rule?
90- maintain BP >90
90- maintain O2 >90%
30- consider head elevation of 30%
4- maintain BSL >4mmol
What drug is used for sedation of combative head injury patients?
Midazolam