head injury

1. TRAUMATIC HEAD AND SPINAL
CORD INJURY
MR.JERRY JAMES
NURSING EDUCATOR
INSTITUTE OF HEALTH ANDMANAGEMENT

2. MECHANISM OF INJURY
Deformation
Acceleration-deceleration
Rotation

3. CLASSIFICATION OF HEAD INJURY
1.DIRECT HEAD INJURY

4. 2. INDIRECT HEAD INJURY

5. OPEN HEAD INJURY

6. CLOSED HEAD INJURY

7. COUP AND COUNTERCOUP INJURY

8. CLASSIFICATION BASED ON THE LOCATION
1.SCALP INJURY
 ABRASIONS
 CONTUSIONS
 LACERATION

9. 2.SKULL FRACTURE
a. Linear fracture

10. b. Depressed skull fracture

11. c. Diastatic
skull fracture

12. d. Basilar skull fracture

13. e. Cranial burst skull fracture

14. f. Compound skull fractures

15. 2. MENINGEAL INJURIES

16. 3.CEREBRAL INJURIES
1.CONCUSSION
Typical signs.
• Altered level of consciousness
• Amnesia
• headache
2.CONTUSION
Typical signs
• Hemorrhage
• Infarction
• Necrosis
• Edema
• Seizure
• Increased I.C.P

17. SPINAL CORD INJURY

18. CLASSIFICATION OF SPINAL CORD
INJURY
1. Hyper flexion
2. Hyperextension

19. 3. Compression injury

20. 4.Rotational injuries

21. 5.Penetrating injury

22. CLASSIFICATION BY DEGREE OF INJURY
• COMPLETE INJURY
• INCOMPLETE INJURY

23. INCOMPLETE INJURY
1.Central cord syndrome
• Motor deficits in the upper extremities
• Less impairment in leg movements
• Sensory loss below the site of injury
• Loss of bladder control may occur

24. 2. Anterior cord syndrome
Loss of perception of pain, temperature and motor
function is noted below the level of the lesion

25. 3. Brown sequard syndrome

26. 4. Conus medullaris and Cauda equina syndrome
• Lower extremity dysfunction
• Loss of bladder and anal sphincter
• function
• Male sexual dysfunction
• Loss of achilles reflex

27. ETIOLOGICAL FACTORS
Road traffic accident
Fall from higher place
Athletic accidents
Blast injuries
Anti coagulant and anti platelet medications
Occupational accidents
penetration

28. PATHOPHYSIOLIOGY OF BRAIN TRAUMA
Brain suffers traumatic injury
Brain swelling or bleeding increase intra cranial volume
Intra cranial pressure increases
Pressure on blood vessels with in the brain increases
Decreased blood flow to the brain
Cerebral hypoxia and ischemia occur
Herniation of the brain
Brain death

29. PATHOPHYSIOLOGY OF SPINAL CORD INJURY
Hemorrhage
RBC and platelet
break down of RBC
Aggregation
Free radical formation
Release of nor epinephrine
Serotonine,dopamine
Vasoconstriction
Thrombosis formation
SC blood flow
secondary injury
spinal edema, tissue hypoxi a

30. CLINICAL MANIFESTATIONS
HEAD TRAUMA
 Altered level of consciousness
 Confusion
 Pupillary abnormalities
 Altered or absent gag and corneal reflex
 Sudden onset of neurological onset
 Changes in vital signs
 Spasticity
 Vertigo
 Seizures
 Ottorhoea
 Rhinorrhoea
 Slurred speech

31. SPINAL CORD INJURY
Spinal shock and neurogenic shock
Respiratory distress
Bradycardia
Poikilothermism
Low blood pressure
Loss of bowel or bladder control
Loss of sensation, including the ability to feel heat, cold
and touch
Difficulty with balance and walking
Loss of movement
Spinal edema

32. CERVICAL INJURIES
C-1/C-2 levels will often result in loss of breathing
C3 vertebrae and above : Typically results in loss of
diaphragm function
C4 : Results in significant loss of function at the biceps and
shoulders.
C5 : Results in potential loss of function at the biceps and
shoulders, and complete loss of function at the wrists and
hands.
C6 : Results in limited wrist control, and complete loss of
hand function
C7 and T1 : Results in lack of dexterity in the hands and
fingers, but allows for limited use of arms

33. THORACIC INJURIES
T1 to T8 : Results in the inability to control the abdominal
muscles
T9 to T12 : Results in partial loss of trunk and abdominal
muscle control.
LUMBOSACRAL INJURIES
Dysfunction of the bowel and bladder
Sexual dysfunction

34. DIAGNOSTIC FINDINGS
Hisory collection
Physical examination
Neurological examination
Ct and m.R.I
Pet scan
Nerve conduction studies
Transcranial doppler studies
X ray
Blood investigation

35. ‘ASIA’ SCALE
AMERICAN SPINAL INJURY ASSOCIATION SCALE
A. Complete
Complete loss of sensory and motor function
b. incomplete
Sensory function is preserved but no motor function
c. incomplete
Motor function is preserved and muscle grade more
than 3
d. incomplete
Motor function is preserved and muscle grade more
than 3
e. normal
Motor and sensory function are normal

36. MANAGEMENT
2/2/2 rule
1. Patient die in 2 mins from airway and breathing
compromise and hypovolemic shock
2. Patient die in 2 hrs from hypovolemic shock
3. Patient die in 2 weeks from septic shock

37. MANGEMENT
Management of trauma patient can be divided in to
2 phase
• Primary phase
• Secondary phase

38. PRIMARY SURVEY
A - AIRWAY
B- BREATHING’
C- CIRCULATION
D- DISABILITY
E- EXPOSURE

39. AIRWAY
Assessment
 Can the patient talk
 Is the patient voice normal
 Stridor
 Foreign body
 Bleeding and secretions
 Mandibular or laryngeal fracture

40. INTERVENTIONS
1. Cervical spine stabilization
2. Sedation
3. Jaw thrust
4. Suction
5. Pulse oximetry
6. Oxygen administration
7. Endotracheal intubation
8. Arterial blood gas analysis

41. BREATHING
Assessment:
LOOK the movement of the chest
Respiratory rate
Flail chest
Cyanosis
Foreign object

42. INTERVENTIONS
• Oxygen administration
• Endotracheal intubation
• Arterial blood gas analysis
• Mechanical ventilation
• Inter costal drainage

43. CIRCULATION
SHOCK
Clinical findings
• Hypotension
• Tachycardia or bradycardia
• Tachypnea

44. CIRCULATION
ASSESSMENT
• External hemorrhage
• Penetrating trauma
• Blunt trauma
• Head injury
• hypotension

45. INTERVENTIONS
Intravenous fluids
Massive transfusion
Direct manual pressure
Hyperventilation
Mannitol
Anticonvulsants
positions

46. DISABILITY
Life threatening disability
• Spinal cord transection
• Intracerebral or intracranial hemorrhage
• Cerebro vascular injury
INTERVENTIONS
• Mobilization
• Neurological assessment
• Glasgow coma scale

47. DISABILITY ASSESSMENT
‘AVPU’ ASSESSMENT
A- AWAKE
V-VERBAL RESPONSE
P-PAINFUL RESPONSE
U-UNRESPONSIVE

48. EXPOSURE
Undress the patient and look for injury
Immobilization
Cover the patient with warm blanket
IV fluids
Patient privacy

49. LIFTING AND HANDLING THE PATIENT
LOG ROLLING

50. SECONDARY SURVEY
Step 1.
‘SAMPLE HISTORY’
S- signs and symptoms
A- allergies
M- medication currently used
P- past illness
L- last meal
E- events/ environment related injury

51. NURSING MANAGEMENT
Monitoring for neurological function
Maintaining the airway
Monitoring fluid and electrolyte balance
Promoting adequate nutrition
Preventing injury
Maintaining body temperature
Maintain skin integrity

52. • Drug management
Methylprednisolone (Medrol)
Atropine and dopamine
Anti coagulants
Sedatives
Analgesics
Osmotic diuretics
Deep vein thrombosis prophylaxis
I.V fluids

53. SURGICAL MANAGEMENT
• Craniotomy or craniectomy
• Decompression laminectomy
NON SURGICAL MANAGEMENT
• The halo and vest system
• Cervical traction