Advanced Head Trauma Pt 2

Advanced Head Trauma 2

Information Covered:

  1. Introduction
    1. Incidence
      1. Head injury
      2. Brain injury
      3. Face injury
    2. Mechanisms of Injury
      1. Motor vehicle crashes
      2. Sports
      3. Falls
      4. Penetrating trauma
      5. Blunt trauma
    3. Morbidity and Mortality
    4. Categories of Injury
      1. Coup
      2. Contrecoup
      3. Diffuse axonal injury (DAI)
      4. Focal
    5. Causes of brain injury
      1. Direct/primary
      2. Indirect/secondary/tertiary
    6. Associated Injuries
      1. Airway compromise
      2. Cervical spine injury
    7. Prevention
  2. Unstable Facial Fractures
    1. Pathophysiology
      1. Categories of Unstable Facial Fractures
        1. Le Fort I - Fracture separates hard palate and lower maxilla from remainder of skill
        2. Le Fort II - Fracture separates the nasal and lower maxilla from the facial skull and remainder of the cranial bones
        3. Le Fort III (craniofacial disjunction) - Fracture separates the entire midface from the cranium.
      2. Blunt trauma to the facial area most frequent cause
    2. Specific assessment considerations
      1. Facial instability
      2. Epistaxis
      3. Edema
      4. Pain
    3. Specific management considerations
      1. Simple airway maneuvers are difficult
      2. Intubation is method of choice for airway protection
      3. Ventilation without intubation is difficult
      4. Manual in-line intubation
      5. Bleeding into the oral cavity; suction
      6. Cricothyroidotomy if indicated
      7. Soft tissue bleeding
  3. Orbital Fractures
    1. Pathophysiology
      1. Blunt trauma to the eye causes increased pressure to the globe of the eye. The pressure causes the weakest area (orbital floor) to give way, causing herniation of orbital contents (inferior oblique muscle entrapment) into the maxillary sinus.
    2. Specific assessment considerations
      1. Mechanism of injury
      2. Sports injury (balls)
      3. enophthalmos
      4. impaired ocular mobility
      5. diplopia
      6. infraorbital hypoesthesia
    3. Specific management considerations
      1. Assess for other injuries
      2. Patching both eyes
      3. Ice to reduce edema
  4. Perforated tympanic membrane
    1. Pathophysiology
      1. Pressure trauma – diving, water skiing
      2. Direct blows
      3. Explosion or barotraumas
      4. Foreign objects
    2. Specific assessment considerations
      1. hemorrhagic otorrhea
      2. hearing loss
    3. Specific management considerations
      1. Supportive care
  5. Skull fractures
    1. Pathophysiology (fracture without brain injury)
      1. Linear
      2. Depressed
      3. Basilar
      4. Location and type of fracture is important
      5. Suspicion of underlying brain injury
    2. Specific assessment considerations
      1. LOC
      2. Hemorrhage control
        1. Depressed skull fractures may require circumferential digital pressure to control an open skill fracture bleed
      3. Fracture lines that cross the middle meningial artery can be serious
      4. Underlying hematoma size can be significant
      5. CSF leakage
    3. Specific management considerations
      1. Spinal cord precautions
      2. AVO
        1. High flow oxygen
        2. Adequate ventilation (not hyperventilation)
        3. No nasal airways of any kind for basilar skull fractures
      3. Document neurological assessment
      4. Transport to appropriate facility
      5. Monitor vital signs
      6. Supportive care
  6. Penetrating neck trauma (non-cord involvement)
    1. Pathophysiology
    2. Specific assessment considerations
    3. Specific management considerations
  7. Laryngeotracheal injuries
    1. Pathophysiology
    2. Specific assessment considerations
    3. Specific management considerations
  8. Spine trauma (non-CNS involvement)
    1. Pathophysiology
    2. Specific assessment considerations
    3. Specific management considerations
      1. Spinal immobilization
      2. AVO
      3. Supportive multi-system care
  9. Mandibular fractures
    1. Pathophysiology
    2. Specific assessment considerations
    3. Specific management considerations
  1. Traumatic brain injury
    1. Pathophysiology
      1. Brain is very oxygen dependent
      2. Brain has very limited oxygen storing capacity
      3. Loss of blood flow for 5-10 seconds causes unconsciousness
      4. Low PacO2 causes vasodilation
      5. High PacO2 causes vasoconstriction
      6. Coup injury to the brain
      7. Contrecoup injury to the brain
      8. Primary brain injury
      9. Secondary brain injury
      10. Center of consciousness (reticular activating system)
      11. Coma
      12. Posturing (decerebrate, decorticate)
      13. Normal intracranial pressure (2 – 12 mmHg)
      14. Cushing’s triad (increased blood pressure, decreased pulse and irregular respirations)
      15. Brain herniation
        1. Uncal herniation
        2. Central herniation syndrome
        3. Cerebellar herniation
      16. Skull fractures
        1. Linear
        2. Depressed
        3. Open
        4. Basilar
      17. Concussion
      18. Diffuse axonal injury
      19. Contusion
      20. Cerebral lacerations
      21. Epidural hematoma
      22. Subdural hematoma
        1. acute
        2. chronic
      23. Subarachnoid hemorrhages
      24. Intracerebral hematomas
      25. Penetrating Brain trauma
    2. Specific assessment considerations
    3. Special management considerations
  2. Spinal cord injury
    1. Pathophysiology
      1. Complete cord lesions
      2. Incomplete cord lesions
      3. Neurogenic shock
      4. Paralytic ileus
    2. Special assessment considerations
      1. Dermatome assessment
      2. Complete
      3. Incomplete
    3. Special management considerations
  3. Spinal shock
    1. Pathophysiology
    2. Special assessment considerations
    3. Special management considerations

 

Content Creator: Dan Livengood

CAPCE Course Number: 17-EMTP-F3-2204

Total CE Hours: 0.75

Level: Advanced

EMT-CE uses the NEMSES guidelines as the foundation for every course outline.