Chapter 23: Head, Facial, & Neck Trauma

Severe head injury is the most frequent cause of trauma death. The temporal bone is one of the thinnest and most frequently fractured cranial bones. Mechanism of Injury Penetrating trauma- injury caused by an object breaking the skin and entering the body. Blunt trauma- injury caused by the collision of an object w/the body in which the object does not enter the body. Types of Skull FX Linear non-displaced Open Depressed Impaled object Basilar Skull fracture. Retroauricular Ecchymosis (Battle Signs)- black and blue discoloration over the mastoid process. Bilateral Periorbital Ecchymosis (Raccoon eyes)- black and blue discoloration around the orbits Brain Injury- (as defined by the National Head Injury Foundation) a traumatic insult to the brain capable of producing physical, intellectual, emotional, social, and vocational changes. Direct Injury- is caused by the forces of trauma and can be associated w/a variety of mechanisms. Coup injury- an injury to the brain occurring on the same side as the site of impact. Contrecoup injury- occurring on the opposite side; an injury to the brain opposite the site of impact. o Types of Direct Brain Injury Focal Injuries- occur at a specific location in the brain and include contusions and Intracranial hemorrhages. Cerebral Contusion- is caused by blunt trauma to local brain tissue that produces capillary bleeding into the substance of the brain. Intracranial Hemorrhage- bleeding that occurs in a location within the brain o Epidural hematoma- accumulation of blood between the dura mater and the cranium. o Subdural hematoma- collection of blood directly beneath the dura mater. Intracerebral hemorrhage- bleeding directly into the tissue of the brain.

Diffuse Injuries- involve a more general scenario of injury and include mild (concussions), moderate, and severe axonal disruptions. Concussions- a transient period of unconsciousness. Moderate Diffuse Axonal Injury- shearing, stretching, or tearing of the axons occurs, but now there is minute bruising of brain tissue. Severe Diffuse Axonal Injury (Brainstem Injury)- is a significant mechanical disruption of may axons in both cerebral hemispheres w/extension into the brainstem. Signs & Symptoms of Brain Injury Altered LOC Altered Level of orientation Alterations in personality Amnesia o Retrograde- inability to remember events that occurred before the trauma that caused the condition. o Anterograde- inability to remember events that occurred after the trauma that caused the condition Cushings reflex o Increasing B/P o Slowing pulse rate o Erratic respirations Vomiting Body temperature changes Changes in reactivity of pupils Decorticate posturing Increase in ICP = B/P & HR Shock = B/P & HR . Assessment of Head, Facial, & Neck Trauma Scene Size-Up Initial Assessment o Airway o Breathing o Circulation Rapid Trauma Assessment o Head o Face o Neck o Glasgow Coma Scale- scoring system for monitoring the neurological status of patients w/head injuries.

 Glasgow of 8 or less Intubate o Vital Signs Focused Hx & Physical Exam Detailed Assessment Ongoing Assessment Medications O2- 12-15 lpm Diuretics o Mannitol o Furosemide (Lasix)- 0.5-1mg/kg Paralytics- paralyzes the skeletal muscles, permitting intubation o Succinylcholine (Anectine)1-1.5mg/kg IV o Pancuronium & Vecuronium Sedatives o Diazepam (Valium)- slow IV bolus 5-10mg o Midazolam (Versed)- 1-2.5mg o Morphine- 5-10mg bolus Atropine- is administered as a 0.5mg bolus for RSI to counter act any Vagus stimulation during intubation. Dextrose Thiamine Topical Anesthetic Spray