Post on 04-Jun-2018
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HEAD TRAUMA
Oleh :Litany alamudi
Pembimbing :Dr. Jovizal,Sp.S
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Layers of the Cranial Vault
Anatomy of the Brainwww.neurosurgery.org/pubpgages/patres/anatofbrain.html#micro
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Definition Traumatic Brain Injury
Traumatic brain injury (TBI) is a seriousneurodisorder commonly caused by car accidents,
sports related events or violence
Review molecular mechanisms in the pathogenesis of traumatic brain injuryhttp://www.hh.um.es
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Mechanisms of Injury for TBI
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Traumatic Brain Injury
Primary Brain Injury
Results from what hasoccurred to the brain at
the time of the injury
Secondary Brain Injury
Physiologic andbiochemical events which
follow the primary injury
World journal of emergency surgerymolecular mechanisms of traumatic brain injury:the missing link in management
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Traumatic Head Injury
www.med.ub.es/All-Net/english/neuropage/trauma/head-8htm
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HEAD INJURIES / BRAIN INJURIES
Skull fractureDiffuse Axonal InjuryEpidural HematomaSubdural Hematoma
Coup contussionContracoup contussion
World journal of emergency surgerymolecular mechanisms of traumatic brain injury:the missing link in management
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EPIDURALANDSUBDURALHEMATOMA
www.med.ub.es/All-Net/english/neuropage/trauma/head-8htm
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SUBDURALHEMATOMA
C d C
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Coup and ContracoupContusions
A combination of vascular and tissue damage leadsto cerebral contusion
Coup contusions occur at the area of direct impact
to the skull and occur because of the creation ofnegative pressure.
Contracoup contusions are similar to coupcontusions but are located opposite the site of
direct impact
World journal of emergency surgerymolecular mechanisms of traumatic brain injury:the missing link in management
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ASSESSMENT
Note: Monitorsecure airway and protect c-spine
Assess breathing
Assess circulation Control major bleeding
Prevent hypotension
Transport decision and interventions
GCS
Guidelines for the management of severe traumatic brain injury 3rd edition
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ASSESSMENT DETAILEDEXAM
Vital signs SAMPLE history Head-to-toe exam, including neurological
and GCS, fluid Continuous observation
Guidelines for the management of severe traumatic brain injury 3rd edition
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Management ofTraumatic Head Injury
Maximize oxygenation and ventilation
Support circulation / maximize cerebral
perfusion pressure
Decrease intracranial pressure
Decrease cerebral metabolic rate
Guidelines for the management of severe traumatic brain injury 3rd edition
P i S d
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Primary vs. SecondaryBrain Injury
Primary injury is immediate from bruising orpenetrating objects
Secondary injury is from hypoxia orperfusion of the brain Caused by swelling, hypoxia, or hypotension Hyperventilation decreases perfusion of the brain
tissueProtect airway, give oxygen, maintain BP
Guidelines for the management of severe traumatic brain injury 3rd edition
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Intracranial Pressure (ICP)
ICP is usually low (15mmhg was one of five
independent risk factors associated with death.
Guidelines for the management of severe traumatic brain injury 3rd edition
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Lowering ICP
Evacuate hematoma Drain CSF Intraventricular catheters use is limited by degree of
edema
Craniotomy Permanence, risk of infection, questionable benefit
Reduce edema Promote venous return Reduce cerebral metabolic rate Reduce activity associated with elevated ICP
Guidelines for the management of severe traumatic brain injury 3rd edition
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Diuretic Therapy
Osmotic Diuretic Mannitol (0.25-1 gm / kg) Increases osmolarity Vasoconstriction
(adenosine)
Loop Diuretic Furosemide Decreased CSF formation Decreased systemic and
cerebral blood volume(impairs sodium and water
movement across blood brainbarrier)
Guidelines for the management of severe traumatic brain injury 3rd edition
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Hypertonic Fluid Administration
Hypertonic saline Comparing mannitol with barbiturates for controlICP after TBI
Guidelines for the management of severe traumatic brain injury 3rd edition
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Anesthetics, Analgetic and sedatives
High dose barbiturate therapy can result in control ofICP when all others medical and surgical treatmentshave failed.
Anticonvulsants - Prevent seizure activity
PentobarbitalAdverse effects include hypotension and bone
marrow dysfunction
Used only after unsuccessful attempts to control
ICP and maximize CPP with other therapies
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Dose regimens
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Factors that Effect Secondary BrainInjuries
Blood PressureOxygenationTemperature
Control of Blood GlucoseFluid Volume Status Increased Intracranial Pressure
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References
Dr. Baxter Larmon, Director of the UCLA CPCand Professor of Medicine, UCLA School ofMedicine
UCLA EMT Lectures, Barry Jensen and EMTTeam, 2003
Brady / DOT paramedic lectures and curriculum
www.emedicine.com
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Evidence SupportingNormoventilation
Forbes et al. (1998) Journal of Neurosurgery, 88(3)
Marion et al. (1995) New Horizons, 3(3)
McLaughlin & Marion (1996) Journal of Neurosurgery, 85(5
Muizelaar et al. (1991) Journal of Neurosurgery, 75(5)
Newell et al. (1996) Neurosurgery, 39(1)
Skippen et al. (1997) Critical Care Medicine, 25(8)
Yundt & Diringer (1997) Critical Care Clinics, 13(1)