Head injury and trauma Flashcards
AMPLE history
- Trauma history
allergies
Medication
PMH
Last ate
Events prior to incident
Tension pneumothorax
Life-threatening pneumothorax where air in pleural space under positive pressure
- Air enters on inspiration but cannot exit due to formation of one-way valve
- Pressure increases progressively
Consequence
- Displaces mediastinal structures
- Collapsed ipsilateral lung
- Compromises cardio-respiratory function
Features
- Tracheal deviation
- Hypotension
Spontaneous pneumothorax
Pneumothorax that occurs spontaneously
- Primary= no underlying lung disease
- Secondary= underlying lung disease
Causes of pneumothorax
Trauma
Underlying lung disease
- COPD
- TB, CF, pneumonia
Iatrogenic
- Ventilation, thoracentesis
Primary = Ruptured subpleural apical blebs
Open pneumothorax
Where air enters into the pleural space through a lesion the chest wall.
- Usually in traumatic penetration
On inspiration= air enters pleural space
- On expiration= air escape to exterior
Closed haemothorax
Air enters in pleural space via hole in lung.
Cerebral perfusion pressure
Net pressure gradient that drives oxygen delivery to cerebral tissue.
Equation= Mean arterial pressure (MAP) - Intracranial Pressure (ICP)
Perfusion decreases with increased intracranial pressure, or decreased MAP.
Effects of raised ICP
Tentorial herniation
- Brain pushed through
Pupillary dilation
- Stretching of CN3
+ Double vision
Motor weakness
- Corticospinal tract compromised
Coma
- Squeezing of medulla
Diffuse axonal injury
Acceleration/ deceleration inury
Extradural haemtoma
Bleed between dura mata and skull
- Convex/ lentiform appearance on CT
Treatment
- Burr hole, craniotomy
Subdural haematoma
Bleed between brain and dura
- Concave appearance on CT
Common in
- Elderly
- Alcoholics
Intracerebral haemorrhage
Bleed in brain associated with cerebral contusions
Coup and contre-coup injuries
- 40% mortalitiy
NICE guideline on CT after head injury
- BANGS LOC
Break
- Open/ depressed skull fracture
Amnesia
- retrograde, >30mins
Neuro
- Deficit/ seizure
GCS
- GCS <13
- GCS <15 2 hours post event
Sickness
- Vomiting (children can vomit 3x)
LOC= loss of consciousness
Also
- Age >65
- Coagulopathy
- Dangerous mechanism (RTA, great height)
Tension PTX
- Management
Resuscitate (ABCDE)
No CXR (emergency)
Largy bore venflon into 2nd IC space, mid-clavicular
Intercostal drainage
Treatment of seizures in head injury
- Lorazepam
2. Phenytoin
