-
Initial management of patients is based on the ABC approach to emergency medicine
- Open the Airway
- Access Breathing
- Check Circulation
-
Most patients will arrive to the ER comatose. This state is one of ocmplete paralysis of cerebral functioin, or complete unresponsiveness. This is the first of five phases of recovery:
- 1) The absence of verbal and motor response, absence of spontaneous eye opening, reflexive eye movements, hyperactive deep tendon reflexes, and decorticate or decerebrate posturing.
- 2)The pt. is semi comatose and begins to withdraw from painful stimuli.
- 3)The pt. is restless, and responds to simple commands.
- 4)The pt. responses are disoriented and confused.
- 5)The pt. has orientation, carryover, and insight. All recovery is dependent on the severity of trauma.
-
Skull fractures (Linear or Comminuted)
Usually reslut from low-velocity objects; whereas, depressed skull fractures result from high-velocity objects. They produce contusions, laceration, cranial nerve damage and a decrease in cranial activity. Depending upon impact there may or may not be subsequent brain damage.
-
Closed Head Injuries
occur without a fracture. It can be a minor injury or profound and irreversible. Damage fro this injury includes brainstem involvement, contusion, diffuse matter lesions, blood vessel damage, and cranial damage
-
Open Head injuries
are the result of compound, depressed skull fractures. Concussions are the most minor brain injury. It is a temporary or permanent loss of consciousness and implies impaired function of the reticular activating system.
-
Subdural Hematomas
usually result from and acute hemorrhage in the subdural space cause by a rupture. They can develop within a week after injury, but could evolve in hours. Approximately 50% are associated w/ skull fractures w/ motor vehicle accidents being the most common cause.
-
Traumatic Injuries
include gunshot wounds, blows to the neck, and injuries to the face or cervical hyperextension
-
Two types of amnesia can occur in a head injury
-
Retrograde Amnesia
the inability to recall memories of known past experiences before the injury
-
Post-traumatic amnesia
- loss of memory for events between the injury and ongoing events
- (What was for breakfast? What happened yesterday?)
|
|