head injuies and maxillo facial Flashcards
Common Causes of TBI
Road traffic collisions (RTC’s) Direct blow Fall from height Sports related Worse outcomes are associated with: Penetrating injuries NAI in children <5 years Pedestrians and cyclists Ejection from a vehicle
Signs and Symptoms of TBI
Lacerations, contusions or haematomas Boggy areas upon palpation Visible deformity of the skull Battle’s sign and/or panda eyes Abnormal pupils Headache Cushing's triad: high BP, low HR, irregular respirations Reduced GCS to name a few……
Pathophysiology
Cerebral blood flow is maintained by ensuring
An adequate pressure to force blood into and around the head – cerebral perfusion pressure (CPP)
a regulatory mechanism – varies resistance to blood flow as the perfusion pressure changes to ensure a constant blood flow
best evidence suggests that a systolic BP of greater tha
90mmHg for neurologically injured patients is desirable”
Primary and Secondary Brain Injury
Primary brain injury happens at the time of injury
Secondary brain injury occurs following the event as a result of hypoxia, hypercarbia or hypoperfusion
Management
Treat any life threatening problems identified in the primary survey and then
“The primary focus in management of TBI is to identify and stop these secondary injury mechanisms”
Deteriorating Patient
Warning signs of increased ICP
Decline in GCS of two points or more Development of sluggish pupil Development of hemiplegia Cushing’s triad Capnography
Complications
Airway compromise – be careful of vagal stimulation as it will increase ICP
C – Spine management – loosen collar when secure (JRCALC, 2016)
Sp02 below 90%
Systolic BP below 90mmHg
Combative patients – consider support from HEMS/EMICS
Maxillofacial Injuries
Involves the maxilla and/or face Common in the UK Causes include falls assault RTC’s
Management Maxillofacial Injuries
Follow the standard AcBCD approach
Airway has the potential to be complicated
Conscious casualty – generally sit them up, leaning forwards for drainage
Unconscious – stepwise airway management, suction
Le Fort fracture – if the maxilla has moved posteriorly , reduce it by holding the upper jaw and pulling firmly
Eyes and Nose
Four types:
Chemical
Corneal abrasions
Blunt trauma
Foreign bodies
Nosebleed (epistaxis)
Direct trauma Nose picking Infection Haemophilia Anti-coagulant and anti-platelet treatment
Nosebleed (epistaxis)
Management
Obtain a good history
ABC
Sit down and lean forwards
Squeeze soft part of their nose and then apply rhino clip nasal clamp
If bleeding continues >30 minutes consider posterior bleed, patient on anti-coags’ and transport to the ED
