Brain, Spine, Maxillofacial, Soft Tissue, and BJM Injuries

traumatic brain injury

collective term to describe wide range types of trauma involving brain

head trauma

occurs when generated force is greater than the cranial vault can absorb

skull fracture

distortion in the integrity of the bony skull

linear fracture

a single blunt strike that creates a fissure line in the cranium

basal skull fructure

results from a backward fall that damages the occiput

anterior basilar skull fracture

results from a forward fall that damages frontal area

depressed skull fracture

result from a fall and may result in laceration of bone tissue

open skull fracture

a perforated scalp is observed

concussion

direct brain injury involving neural tissue, temporary loss of consciousness due to interruption of brain functioning

contusion

bruising of the brain when the head suffers direct impact with a rigid object

diffuse axonal injury

extensive brain damage involving wide area from cerebrum and brainstem, innermost centro-axial areas of neural white matter

intracranial hemorrhage

significant bleeding into a space or potential space between skull and brain

epidural bleed

bleeding between the skull and dura mater

subdural bleed

bleeding between the dura mater and arachnoid

subarachnoid bleed

bleeding between the arachnoid and pia mater

skull > dura mater > arachnoid mater > pia mater

skull to brain anatomy

• epidural

• subdural

• subarachnoid

Monro Kellie Hypothesis

“there is only enough space in the head, if bleeding is too much, ICP increases”

hypertension and bradycardia

two late signs of increasing CIP

unequal or unresponsive pupils

signifies active brain bleed

battle’s sign

preauricular ecchymosis; a bluish discoloration behind the ears

• basal skull/occiput fracture

racoon’s eyes

periorbital ecchymosis

• common in anterior basilar skull fracture

rhinorrhea

CSF leak in the nose

otorrhea

CSF leak in the ear

• pia mater is no longer intact if there is any CSF leak

jaw thrust maneuver, stand by oral suction, high flow oxygen, control bleeding, don’t attempt to stop flow of blood and CSF

five primary management for traumatic brain injury

for number 2, do not stimulate gag reflex

battle signs, racoon’s eye, rhinorrhea, otorrhea

four unique signs for traumatic brain injury

ascending infection

type of infection that CSF leak may cause

anticonvulsants (diazepam), mannitol, antibiotics, antipyretics

four drugs for traumatic brain injury

basilar fracture and severe midface fractures

NGT is contraindicated for this two types of fracture

• may perforate brain through the fractured portions

cervical spine injury

injuries to the cervical spine due to crushing, stretching, and rational shear forces

• quadriplegia

• radicular pain in neck, occipital region, shoulders

• loss of bowel and bladder control

• loss of sweating and vasomotor tone

edema and cord swelling

(2) contributes further loss of spinal cord function and neurological manifestations

• that’s why steroids are given to reduce inflammation

lesions at or above C4

weakness or paralysis of the diaphragm may occur with?

priapism

persistent erection of the penis

hypothermia

CSI patients has inability to constrict peripheral blood vessels and conserve body heat

Hoffman’s sign

flicking of the middle finger induces flexion of the ipsilateral thumb or index finger

quadriplegia, priapism, hypothermia, Hoffman’s sign

four unique signs of cervical spine injury

immobilize cervical spine with C-collar, jaw-thrust maneuver, intubate nasally, bag-valve mask assist respiration

four primary interventions for CSI management

• for fourth, if respiration is shallow

hypotension, hypothermia, bradycardia

three things to monitor for CSI

Methylprednisolone 30 mg/kg IV loading for 15 minutes, 5.4 mg/kg/hr infusion 45 minutes after for 23 hours

drugs for CSI - high dose steroids

maxillofacial trauma

injuries to the head frequently result in facial lacerations and fractures to the facial bones

• assess for potential eye injury, vision loss, diplopia, eye pain

• examine mouth for broken/missing teeth

• immobilize spine

• may have rhinorrhea and otorrhea

• apply ice to injury, except eyes

paralysis of the upward gaze

indicative of inferior orbit fracture (blowout fracture)

crepitus on palpation around nose

indicative of nasal fracture

malocclusion of teeth

indicative of maxilla or mandible fracture

palpable flattening of cheek and loss sensation below orbit

indicative of zygomatic (cheekbone) fracture

trismus and mobility of jaw

indicative of maxillary fracture

dentist, EENT, ophthalmologist

three doctor specialization that may be paged in patient suspected with maxillofacial trauma

pain relivers and sedative

two drugs for maxillofacial trauma

encephalitis and meningitis

two types of infection that can occur if patient has CSF leak

closed wound

an injury to the soft tissue without a break in the skin

• patients may develop shock

contusion, hematoma, blunt trauma

three types of closed wound

contusion

bleeding beneath the skin into the soft tissues

hematoma

well-defined pocket of blood and fluid beneath the skin

blunt trauma

caused by a sudden force over the chest and abdomen, possible internal bleeding

open wound

an injury to the soft tissue with a break on skin

• patients may develop shock

abrasion

superficial loss of skin resulting from rubbing/scraping against rough surface (gas gas)

laceration

tear in the skin, incisional or jagged

• can be partial or full thickness

puncture

occurs when skin is penetrated by a pointed object

avulsion

involves tearing off or loss of a flap of skin (wak wak)

amputation

traumatic cutting off of a finger, toe, arm, or leg

direct pressure, elevation, pressure points

three things to do with excessive bleeding (soft tissue injury)

• for third, used when direct pressure can’t stop the bleeding or not possible

50 ml per inch of wound per hour of age of wound

general irrigation rule for wound preparation (soft tissue injuries)

• you shave the area first

• use isotonic sterile saline solution

• anesthesia, if patient can’t tolerate irrigation

  • regional block or local intradermal

closure by primary intent

(type of wound closure) wound is repaired without delay after injury, yield fastest healing

• sutures, skin tapes, staples, adhesives

closure by secondary intent

(type of wound closure) wound is allowed to granulate on its own

• cleaned and covered with sterile dressing

closure by secondary intent with delayed closure

(type of wound closure) wound is cleaned and dressed

• returns in 3 to 4 days for definitive closure

contact, absorbent, outer wrap

three layers of wound dressing

contact layer

(layer of wound dressing) first layer, consists of non-absorbent hydrophilic dressing (w/ antibiotic)

absorbent layer

(layer of wound dressing) second layer, usually constructed of surgical dressing pads

outer wrap

(layer of wound dressing) third layer, holds the dressing in place

• rolled gauze and tapes

antibiotic, tetanus prophylaxis, pain medications

three medications for soft tissue injuries

fractures

a break in the integrity of the bone

dislocation

complete displacement or separation of a bone from its normal place of articulation

• deformity

• short limb

sprains

ligaments are partially torn or stretched, twisting of joint beyond normal range

• pain in joint

• discoloration

• edema possibly ecchymoses

strains

stretching or tearing of muscles and tendon fibers

• caused by overexertion or overextension

• minimal swelling

PRICE, protect rest ice comfortable support elevate

soft tissue and closed fracture treatment

• put pads, stop moving injury

• supportive bandage

• elevate reduce swelling

20 minute ice pack, immobilize injury without straightening, support while transferring, cover breaks with sterile dressing

(4) first aid care for sprains and broken bones

bandaging

first aid procedure, covering break in skin to stop bleed, stabilize, and protect