Major Trauma

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Head Trauma

  • Most common forces involved in head trauma:

    • Blunt acceleration forces (when the head is struck with an object)

    • Deceleration forces (when the head is moving and strikes a stationary object)

    • Penetrating forces (when an object enters the head)

  • Missed injuries, including secondary neurologic injuries, are common in emergency care settings.

  • Complications of neurologic injuries often develop slowly, sometimes hours or even days after the initial trauma.

  • Two fundamental goals for neurological assessment:

    • Identify any obvious signs of head trauma and underlying neurological injury.

    • Provide baseline data which can be used to identify a developing neurological injury.

Neurological Assessment

  • Assessment of level of consciousness (using the Glasgow Coma Scale).

  • Assessment of pupillar size, equality, and reactivity to light.

  • Assessment of cranial nerves III, IV, and VI.

  • Major Trauma / Other Trauma 1

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Neurological Assessment (continued)

  • Assessment of motor symmetry and strength.

  • Assessment of vital signs.

  • Computed tomography (CT) scan of the head is recommended in certain cases.

  • Most Common Head Injuries and their Management in the Emergency Care Setting.

  • Scalp lacerations are typically managed by direct pressure and subsequent wound repair.

  • Skull fractures may require surgical repair depending on the severity.

  • Signs of suspected skull fracture include hemotympanum, 'panda' or raccoon eyes, leakage of cerebrospinal fluid, and Battle's sign.

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Head Injuries (continued)

  • Contusion occurs when acceleration-deceleration forces are involved in the injury.

  • Subdural or epidural hematoma involves bleeding beneath or between the skull and one of the layers of the dura mater or arachnoid mater.

  • Concussion is a mild traumatic brain injury that involves a loss of consciousness and associated disruptions to neurological functioning.

  • Diffuse axonal injury (DAI) is a severe traumatic brain injury that results in shearing of axons within the white matter of the brain.

  • Increased intracranial pressure (ICP) can be caused by cerebral edema or an increase in cerebral blood flow.

  • Management of increased ICP involves treating underlying causes and may include medication and surgical therapy.

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Increased ICP (continued)

  • Patients with increased ICP will present with decreased LOC, changes in vital signs, pupillary dilatation, decrease in motor function, severe headache, and nausea/vomiting.

  • Management of increased ICP involves managing its underlying causes.

  • Focus treatment on treating the greatest threat to life first and effectively managing the patient's pain.

  • Use small but frequent doses of intravenous opioids for pain management.