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Wednesday, 22 May 2013

Dos and Don’ts in Head Injury

Dos and Don’ts in Head Injury
Impacted foreign body-Head and Neck

Impacted foreign body-Head
  
Decompressive Craniotomy

Dos and Don’ts in Head Injury
ž External Bleeding-Pressure Bandage
ž Internal Bleeding or CSF Leak-Do not try to stop
ž Head to be Tilted to one side- To avoid Aspiration
ž Do not pull out an impacted foreign body-At the site of the Event!

Classification of Brain Injury -Primary and Secondary
Primary brain injury -Injury caused at the time of impact- acute neuronal damage & cell death---directly due to      traumatic force-and is irreversible in nature.
  Examples:-
       Cerebral concussion ( No anatomical damage)
       Cerebral contusion ( Both anatomical & Functional damage)
       Laceration
       Diffuse axonal injury

Secondary brain injury  -occurring anytime after the primary impact and it is preventable from of head injury.

     Causes of secondary brain injury
      ■ Hypoxia: PO2 < 8 kPa
      ■ Hypotension: systolic blood pressure (SBP) < 90 mmHg
      ■ Raised intracranial pressure (ICP): > 20 mmHg
      ■ Low cerebral perfusion pressure (CPP): < 65 mmHg
      ■ Pyrexia
      ■ Seizures
      ■ Metabolic disturbance

Clinical situations in Trauma
Situation 1.
  HYPERTENSION + BRADYCARDIA= HEAD INJURY
Situation 2.
  HYPOTENSION +BRADYCARDIA=  SPINAL  INJURY
Situation 3.
  HYPOTENSION +TACHYCARDIA= HYPO VOLUMEA
  Suspect - Thoracic/Abdominal-injury/Poly trauma
Situation 4.            
  HYPERTENSION +TACHYCARDIA= STRESS/ HYPOXIA
           

 

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