Head Injury כל הזכויות שמורות למד"א מרחב ירושלים. Dan Drory, EMT-P, Instructor
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1 Head Injury Dan Drory, EMT-P, Instructor
2 Anatomy on a fingertip The brain is a soft and gentle tissue. The brain is the most important organ. כל הזכויות שמורות למד"א מרחב ירושלים Protective layers of the brain: Hair Skin Scull Dura matter Arachnoid matter Spino Cerebral Fluid Pia matter
3 Pay attention Traumatic Brain Injury is the leading cause of death in trauma. Every decrease in the Level Of Consciousness, suspect TBI, call for MICU. The most reliant way to estimate TBI in patient is LOC.
4 Elevated Intra Cranial Pressure Scull provides a closed space. The pressure inside it varies by small values. Normal values state normal ICP. As the pressure inside the scull rises slightly above normal values ( because of swelling\bleeding ), impairment of brain function takes place. The location of the injury will dictate the neurological deficit.
5 So who is at risk? Many resources are being invested to minimize the percentage of TBI. כל הזכויות שמורות למד"א מרחב ירושלים For now, it seems that the only thing that can assure you will never suffer a traumatic brain injury is a lack of that organ. If you are not smiling right now, you re at low risk.
6 Concussion Because of a blunt injury, brain smacks from side to side inside the scull.
7 Signs of Concussion Momentary loss of consciousness Dizziness Nausea \ Vomiting Blurred or double vision Confusion Amnesia In some cases those signs will appear after several hours
8 Dangers Elevated Intra Cranial Pressure ( EICP ) because of edema ( swelling ) or bleeding.
9 Depressed fractures A powerful impact may produce a fracture in witch fragments of bone are driven toward or into the underlying brain tissue. A small nondepressed fracture, may increase the chance of an intracranial hematoma. A bleeding from an open fracture can cause a fatal bleeding.
10 Basilar Scull Fracture A bleeding from veins surrounding the base of scull will advance to soft tissue of the head around the eyes and behind the ears. This will usually appear after several hours of an injury. The presentation is Racoon eyes and Battle sign, with CSF drainage from ear and nose canals.
11 Jaw fractures Maxilla is the upper jaw. When broken, loose teeth and extensive bleeding, will endanger the airway by sufication. Swallowing blood may cause vomiting. Mandible is the lower jaw. When broken, the patient might suffer from a compromised airway from loose base of thong as well as the complications similar to Maxilla fracture.
12 Intra Cranial Bleeding Epidural arterial bleeding fast, higher pressure, relatively easier to fix. Subdural venous bleeding slow (some times days), lower pressure, relatively difficult bad access, old injury. In both cases, tissue will suffer. The longer it suffers, the worse is the outcome. Time = Brain!
13 Signs of EICP Scene\Kinematics Story Common Signs: Nausea \ Vomiting Decrease of mental status (Level Of Consciousness) Combatant Patient CSF Drainage from ears and nose Unclear speech Loss of short\long tem memory Less common signs: Slow pulse High Systolic and Diastolic Values Changes in breathing patterns Unequal pupils ( Difficult skill to master ) When all of those appear, it s bad for sure!
14 When things don t add up Check blood sugar. Rule out heart condition as a cause for TBI. Rule out convulsions prior to the TBI.
15 Treatment Patient Assessment- Oxygen C-Spine and Spine fixation Bandage Consider asking for MICU Evacuate to a suitable trauma center
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