MOD E Tech 32 Head & Maxillofacial injuries Flashcards
Head Anatomy
Intracranial Contents:
Intracranial Contents:
•
- Brain – 80%
- Blood – 12%
CSF – 8%
Head Trauma - Types
Open
•Skull compromised
and brain exposed
Closed
•Skull not compromised
and brain not exposed
•Contra Coup injury
Head Injuries – Scalp Wounds
Scalp wounds
- Highly vascular, bleeds briskly
- May be difficult to pinpoint the source
- Patient may suffer concussion
Base of Skull Fracture
signs
Brain Injury
Primary brain injury
•Immediate damage
due to force
- Coup and contracoup
- Fixed at time of injury
- Localised
- Diffuse
Management
•Directed at prevention
Brain Injury
Secondary brain injury
Secondary brain injury
•Results from hypoxia, hypercarbia
or decreased perfusion
- Response to primary injury
- Develops over hours
Management
•Good prehospital care can help prevent
Brain Injury
Response to injury
Response to injury
- Swelling of brain
- Vasodilatation with increased blood volume
- Increased ICP
- Decreased blood flow to brain
- Perfusion decreases
- Cerebral ischemia (hypoxia)
Early efforts
to maintain brain perfusion
can be life-saving.
Brain Injury - Contusion
Cerebral contusion
- Bruising of brain tissue
- Swelling may be rapid and severe
- Level of consciousness
•Prolonged unconsciousness,
profound confusion or amnesia
- Associated symptoms
- Focal neurological signs
- May have personality changes
Brain Injuries – Vascular Damage
Intracranial haemorrhage
- Epidural / Extradural
- Between skull and dura
- Subdural
- Between dura and arachnoid
- Intracerebral
- Directly into brain tissue
Intracranial Haemorrhage
Intracranial Haemorrhage
Acute epidural haematoma
Intracranial Haemorrhage
Acute subdural haematoma
Consequences & Complications of Head Injuries
Consequences & Complications of Head Injuries
Compression
- Extradural and sudural haematomas can cause a sudden or gradual increase in ICP
- Large pressure changes can result in shifting of the brain and “coning” of the brain stem
- A deterioration in level of consciousness is an important indicator of an increasing ICP
- Deterioration in LOC
- Noisy, slow breathing (Cheyne-Stokes in terminal stages)
- Slow, full pulse
- Raised temperature
- Hot, flushed face
- Unequal pupils – dilated and fixed on side of injury
- Unilateral facial or body weakness / paralysis
- Intense headache
- Convulsions
Assessment
Pupil Reaction
Maxillofacial Injuries
- Maxillofacial injuries are often associated with head and neck injury
- Therefore they present a unique range of problems in terms of patient positioning and airway management
Maxillo Facial Injuries
Special Problems
- Facial distortion, bruising & swelling may mask a fracture
- CSF leakage
- Damage to teeth
- Loss of cough reflex
- Sense of taste & smell affected
- Double vision
- Inability to close jaw
Airway & Breathing issues to think about
- What may obstruct the airway?
- Consider use of “unusual” airway maintenance, especially in facial fractures
- Masks may not fit properly
- Because the face is very vascular, profuse bleeding may be present, necessitating constant suction
CSF Leakage
- CSF may be identified as a pale/colourless liquid leaking (normally) from the nose or ears
- Where is CSF normally contained?
- What does CSF leakage imply?
- What are the consequences of this for the patient?
Management
Maxillo Facial Injuries
- Ensure open airway – may require suction
- Consider cervical spine damage
- Postural drainage
- Control bleeding
- Take broken dentures / avulsed teeth to hospital
- Encourage patient not to speak
Eye Injuries
Eye Injuries - Types
Eye Injuries - Management
Chemical contamination:
Chemical contamination:
- Flush the eye with copious amounts of water
- If safe to do so – retain a sample of the chemical for the hospital
- Reduce eye movement – cover both eyes
- Do not apply direct pressure to the eye itself
- Consider removal to specialist department
Eye Injuries - Management
Embedded Objects or Injuries
Embedded Objects or Injuries
- Do not remove embedded foreign bodies
- Cover both eyes
- Do not apply direct pressure to the eye itself
- Consider removal to a specialist department
- Reassurance
- Constant communication
- Be aware of displaced contact lenses
- Avoid unnecessarily tampering with eye injuries
- Reassurance
- Constant communication
- Be aware of displaced contact lenses
- Avoid unnecessarily tampering with eye injuries
