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Questions to askQuestions to ask
What is head injuryWhat is head injury
What are favorable factors in head injuryWhat are favorable factors in head injury
What are adverse factors in head injuryWhat are adverse factors in head injuryHow to diagnose a serious head injuryHow to diagnose a serious head injury
How to treat a serious head injuryHow to treat a serious head injury
Any other questions????Any other questions????
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Anatomical considerationsAnatomical considerations
The skull contains brain covered byThe skull contains brain covered by
meningesmeninges
80% of cranial cavity is occupied by brain80% of cranial cavity is occupied by brainMeninges: dura, arachnoid, and pia materMeninges: dura, arachnoid, and pia mater
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Anatomical considerationsAnatomical considerations
Cranial cavity is a closed cavityCranial cavity is a closed cavity
It has rigid, non resilient wallsIt has rigid, non resilient walls
Blood flow is autoregulatedBlood flow is autoregulatedBrain is a soft organBrain is a soft organ
The meningeal arteries run close to theThe meningeal arteries run close to the
bonesbonesThe brain is suspended in cerebrospinalThe brain is suspended in cerebrospinal
fluidfluid
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Physiological considerationsPhysiological considerations
Functions of brain: motor, sensory,Functions of brain: motor, sensory,
cognition, volition, and intellectualcognition, volition, and intellectual
functions.functions.Control of autonomic functionsControl of autonomic functions
Control of posture, coordination, andControl of posture, coordination, and
equilibriumequilibrium
Special senses smell, vision etc.Special senses smell, vision etc.
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Physiologic considerationsPhysiologic considerations
Brain; very busy organBrain; very busy organ
Consumes 20% of body oxygenConsumes 20% of body oxygen
Largest glucose userLargest glucose userNo time to store nutrients (busy organ)No time to store nutrients (busy organ)
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Head injuryHead injury
Blunt injuryBlunt injury
Penetrating injuryPenetrating injury
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Types of injuryTypes of injury
Coup injuryCoup injury
CounterCounter--coup injurycoup injury
Diffuse axonal injuryDiffuse axonal injuryFocal injuryFocal injury
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CLASSIFICATIONCLASSIFICATION
According to morphologyAccording to morphology
Scalp injuriesScalp injuries
Skull fracturesSkull fractures Intracranial injuriesIntracranial injuries
Diffuse neuronal injuryDiffuse neuronal injury
Hematoma: extradural, subdural, intracerebralHematoma: extradural, subdural, intracerebral
Primary brain injuryPrimary brain injury
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SCALP LACERATIONSSCALP LACERATIONS
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SCALP HEMATOMASCALP HEMATOMA
(The Raccoon Eyes)(The Raccoon Eyes)
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SCALP HEMATOMASCALP HEMATOMA
(The Raccoon Eyes)(The Raccoon Eyes)
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Assessment: GCSAssessment: GCS
GCS: Glasgow coma scoreGCS: Glasgow coma score
3 parameters:3 parameters:
Best eye responseBest eye response Best verbal responseBest verbal response
Best motor responseBest motor response
Max score 15Max score 15Min score 3Min score 3
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GLASGOW COMA SCOREGLASGOW COMA SCORE
Eyes openingEyes opening
SpontanousSpontanous 44
To verbal commandTo verbal command 33 To painTo pain 22
NoneNone 11
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GLASGOW COMA SCOREGLASGOW COMA SCORE
Best verbal responseBest verbal response
OrientatedOrientated 55
ConfusedConfused 44 InappropriateInappropriate 33
IncomprehensibleIncomprehensible 22
NoneNone 11
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GLASGOW COMA SCOREGLASGOW COMA SCORE
Best motor responseBest motor response
Obeys commandsObeys commands 66
Localises painLocalises pain 55 Withdrawal to painWithdrawal to pain 44
Flexion to painFlexion to pain 33
Extension to painExtension to pain 22
No motor responseNo motor response 11
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GLASGOW COMA SCOREGLASGOW COMA SCORE
MAX POSSIBLE= E4+V5+M6=15MAX POSSIBLE= E4+V5+M6=15
MIN POSSIBLE= E1+V1+M1=3MIN POSSIBLE= E1+V1+M1=3
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SEVERITY OF HEAD INJURYSEVERITY OF HEAD INJURY
Mild: GCS=13Mild: GCS=13--1515
Moderate: GCS=8Moderate: GCS=8--1212
Severe: GCS=3Severe: GCS=3--77
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InvestigationsInvestigations
XX--ray skull AP & latray skull AP & lat
CT scanCT scan
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THE CT SCANTHE CT SCAN
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THE CT SCANTHE CT SCAN
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THE CT SCANTHE CT SCAN
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INVESTIGATIONSINVESTIGATIONS
XX--ray skullray skull
CT scanCT scan
ICP monitoring (intra cranial pressureICP monitoring (intra cranial pressuremonitoring)monitoring)
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ICP MONITORINGICP MONITORING
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ACUTE EXTRADURALACUTE EXTRADURAL
HEMATOMAHEMATOMASource: meningeal arteries esp middleSource: meningeal arteries esp middlemeningeal arterymeningeal artery
Diagnosis: clinical evaluation (lucidDiagnosis: clinical evaluation (lucidinterval), CT scan appearance (lenticularinterval), CT scan appearance (lenticular
mass)mass)
Treatment: evacuation by craniotomyTreatment: evacuation by craniotomy
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ACUTE SUBDURALACUTE SUBDURAL
HEMATOMAHEMATOMASource: cerebral veinsSource: cerebral veinsCommonest in occurrenceCommonest in occurrence
Diagnosis: clinical evaluation, CT scanDiagnosis: clinical evaluation, CT scanappearance (crescentic mass)appearance (crescentic mass)
Treated by evacuation through craniotomyTreated by evacuation through craniotomy
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ACUTE SUBDURALACUTE SUBDURAL
HEMATOMAHEMATOMA
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RAISED INTRACRANIALRAISED INTRACRANIAL
PRESSUREPRESSURESymptoms:Symptoms: Impaired level of conciousnessImpaired level of conciousness
HeadacheHeadache
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RAISED INTRACRANIALRAISED INTRACRANIAL
PRESSUREPRESSURESignsSigns Impaired level of consciousnessImpaired level of consciousness
Rising BPRising BP
Slowing pulseSlowing pulse
Slowing respirationSlowing respiration
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DIAGNOSIS OF RAISED ICPDIAGNOSIS OF RAISED ICP
Clinical evaluationClinical evaluation
ICP monitoringICP monitoring
X ray skull AP & latX ray skull AP & latCT scanCT scan
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MANAGEMENT OF RAISEDMANAGEMENT OF RAISED
ICPICPEvaluation and observationEvaluation and observationHyperventilationHyperventilation
OO22 inhalationinhalation
Treatment of mass lesionsTreatment of mass lesions (evacuation of(evacuation ofhematomas)hematomas)
Iv mannitolIv mannitol
Iv frusemideIv frusemideIv dexamethasone??Iv dexamethasone??
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A COMPREHENSIVE SCHEME OFA COMPREHENSIVE SCHEME OF
MANAGEMENT OF HEAD INJURYMANAGEMENT OF HEAD INJURY
The ATLS approach: the primary surveyThe ATLS approach: the primary survey
(ABCDE)(ABCDE)
AAirwayirway
BBreathingreathing
CCirculationirculation
DDysfunction of cnsysfunction of cns
EExposurexposure
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THE PRIMARY SURVEYTHE PRIMARY SURVEY
((AABCDE)BCDE)Airway:Airway: The finger sweepThe finger sweep
The jaw liftThe jaw lift
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THE PRIMARY SURVEYTHE PRIMARY SURVEY
((AABCDE)BCDE)The airway:The airway: The artificial airwayThe artificial airway
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THE PRIMARY SURVEYTHE PRIMARY SURVEY
(ABCDE)(ABCDE)The airwayThe airway The ambu bagThe ambu bag
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THE PRIMARY SURVEYTHE PRIMARY SURVEY
((AABCDE)BCDE)The airway:The airway: The artificial airwayThe artificial airway
LaryngoscopyLaryngoscopy
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THE PRIMARY SURVEYTHE PRIMARY SURVEY
((AABCDE)BCDE)The airway:The airway: Endotracheal intubationEndotracheal intubation
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THE PRIMARY SURVEYTHE PRIMARY SURVEY
((AABCDE)BCDE)Airway:Airway: CricothyroidotomyCricothyroidotomy
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THE PRIMARY SURVEYTHE PRIMARY SURVEY
((AABCDE)BCDE)The airway:The airway: TracheostomyTracheostomy
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TRACHEOSTOMYTRACHEOSTOMY
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THE PRIMARY SURVEYTHE PRIMARY SURVEY
(A(ABBCDE)CDE)Breathing:Breathing: Chest cageChest cage
PleuraPleura
Respiratory musclesRespiratory muscles
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THE PRIMARY SURVEYTHE PRIMARY SURVEY
(A(ABBCDE)CDE)
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THE PRIMARY SURVEYTHE PRIMARY SURVEY
(A(ABBCDE)CDE)
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THE PRIMARY SURVEYTHE PRIMARY SURVEY
(AB(ABCCDE)DE)CirculationCirculation
PulsePulse
Blood pressureBlood pressure
Central venous pressureCentral venous pressure
IV lines, CVP line, IV fluidsIV lines, CVP line, IV fluids
Volume replacement & hemodynamic stabilityVolume replacement & hemodynamic stability
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THE PRIMARY SURVEYTHE PRIMARY SURVEY
(ABCDE)(ABCDE)
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THE PRIMARY SURVEYTHE PRIMARY SURVEY
(ABCDE)(ABCDE)
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THE PRIMARY SURVEYTHE PRIMARY SURVEY
(ABC(ABCDDE)E)Dysfunction of cnsDysfunction of cns
AlertnessAlertness
Verbal responseVerbal response
PupilsPupils
GCS scoringGCS scoring-- baseline assessmentbaseline assessment
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MANAGEMENT OF HEADMANAGEMENT OF HEAD
INJURYINJURYAdmission to hospitalAdmission to hospital
Impaired conciousnessImpaired conciousness
History of unconciousnessHistory of unconciousness
Skull fractureSkull fracture
Children below 5yrsChildren below 5yrs
The drunk or intoxicatedThe drunk or intoxicated
Associated injuriesAssociated injuries
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MANAGEMENT OF HEAD INJURYMANAGEMENT OF HEAD INJURY
Iv lineIv line
Ventilation and oVentilation and o22 inhalationinhalation
Imaging:Imaging:
X ray skull ap & latX ray skull ap & lat
X ray cervical spine ap & latX ray cervical spine ap & lat
Ct scanCt scan
The gcs scoringThe gcs scoring(Contd)(Contd)
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MANAGEMENT OF HEAD INJURYMANAGEMENT OF HEAD INJURY
ICP monitoringICP monitoring
Management of raised ICPManagement of raised ICP
Definitive therapy e.g. Operation,Definitive therapy e.g. Operation,evacuation of hematomaevacuation of hematoma
Symptomatic treatmentSymptomatic treatment
RehabilitationRehabilitation
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MANAGEMENT OF HEAD INJURYMANAGEMENT OF HEAD INJURY
ICP monitoringICP monitoring
Management of raised ICPManagement of raised ICP
Definitive therapy e.g. Operation,Definitive therapy e.g. Operation,evacuation of hematomaevacuation of hematoma
Symptomatic treatmentSymptomatic treatment
RehabilitationRehabilitation
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QuestionsQuestions to answerto answer
What is head injuryWhat is head injury
What are favorable factors in head injuryWhat are favorable factors in head injury
What are adverse factors in head injuryWhat are adverse factors in head injuryHow to diagnose a serious head injuryHow to diagnose a serious head injury
How to treat a serious head injuryHow to treat a serious head injury
Any other questions????Any other questions????
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Questions?Questions?
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