Head Injuries Flashcards
What are most preventable prehospital deaths due to?
Hemoragic shock or tension physiology.
What is the key point to managing a head injury?
Maintain oxygen and nutrients to the brain.
What is the skull?
An inflexible cavity with no free space.
What is in the skull.
Brain matter.
Arteries and arterial blood.
Veins and venous blood.
CSF
What is interracial pressure?
An intrinsic pressure within the cranial cavity that is quite low 10mmHg but can be measured with Lumbar puncture.
What is Cerebral Prefusion Pressure?
The difference between ICP and BP that allows blood to enter the cranial cavity.
What does a large part of neurocritical care consist of?
Maintenance of cerebral profusion pressure through either increasing arterial pressure into the brain or decreasing the pressure in the cranium by removing the clot or CSF, reducing brain swelling or removing the skull.
What can you do for the initial trauma with a brain injury?
Not a lot.
What problems will make a head injury worse.
Hypoxia
Hypercarbia
Hypoperfusion
Hypo/hyperglycaemia
What MOIs can lead to head injury?
Penetrating-
Bullets
Fragmentation
Blunt- Falls Direct Trauma RTC Blast
What might you see that will lead you to suspect a head injury?
Racoon eyes
Rhinorrhoea- csf and blood from nose
Otorrhea-from ear
Mastoid process bruising- behind the ears
What do you record for head injury level of consciousness?
AVPU
GCS
PEARL
Size
Waht is the AVPU scale
Alert
Voice
Pain
Disability
What is the 3 categories for gcs
Eye response
Verbal
Motor
What is worse flexion or extension to pain?
Extension.
What GCS and bellow is considered a severe head injury?
8
What is the highest and lowest gcs?
15 and 3
What happens with Cushings Reflex?
Pulse goes down.
BP goes up.
GCS goes down
Resp usually go down
What do patients experiencing Cushings Reflex need?
Urgent critical care, a brain scan and potentially surgical intervention.
How are head injuries treated and managed?
Airway- clear and maintain
Breathing- give O2 aiming for 94-98% SP02
BVM if low resp rate to blow off CO2
Consider 30 degree tilt to drain venous blood from cranium. (Not for spinal injury)
Circulation- Maintain normal tension SBP 110
Disbility- Correct hypoglycemia
What can we do in a non-permissive environment?
Cat heam
What can we do in a permissive environment?
C- acat heam A- Check, Clear, Maintain C spine if needed B- RISE'N'FALL C- Maintain BP E- Keep warm
What extra can we do in a permissive environment?
GCS
Movement for pressure sores
Stretcher movement
HITMAN
What should you not do if you consider ICP?
Use a collar.
