Beruflich Dokumente
Kultur Dokumente
AN INTRODUCTION
GUIDELINES
HEAD INJURY
Quality Improvement in
Emergency Medical Services
Better application of critical
care methodologies
WHAT IS THE GOAL ?
To Facilitate Healing
To Prevent Secondary Brain Damage
Optimal milieu
Injured
Neuron
Suboptimal milieu
• Hypovolemic shock
• Severe Dehydration
Hypoxia caused by :
• Severity
• Mild
• Moderate
• Severe
• Morphology
• Skull Fracture
• Intracranial Lesion
• Mechanism
High Velocity
CLOSED
Low Velocity
Gunshot Wound
PENETRATING
Other open
injuries
• Severity
MILD
GCS 13 - 15
GLASGOW MODERATE
COMA SCALE GCS 9 - 12
TEASDALE AND
JENNETT 1974
SEVERE
GCS 3 - 8
• Morphology
VAULT
LINEAR OR STELLATE
DEPRESSED
SKULL
FRACTURES
BASILAR
CSF LEAK
NERVE VII PALSY
• Morphology
FOCAL
EPIDURAL
SUBDURAL
INTRACEREBRAL
INTRACRANIAL
LESION DIFFUSE
MILD CONCUSSION
CLASSIC CONCUSSION
DIFFUSE AXONAL
INJURY
• EVALUATION
Loss of
consciousness
Headache &
vomitting
HISTORY OF
ILLNESS
Seizure
Mechanism ?
• EVALUATION
State of A B C
G C S, pupil, motoric
Other injuries
• MANAGEMENT
• Oropharyngeal tube
• IV line
Nasogastric tube
• Preventing aspiration
Pharmalogical Intervention
• Pain killer
• Antibiotic
RADIOLOGICAL EXAMINATION
Skull X Ray
• Skull bone
Head CT Scan
• Gold standard
• Indication
• When
• How
• Complication
Surgical Intervention
Indication
• Mass effect : midline shifting > 5 mm
• Depressed fracture > 1 diploe
• Penetrating head injury
• Headache