Head Injury - Head & Spine Injuries M. Jamous M.D...

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Unformatted text preview: Head & Spine Injuries M. Jamous M.D Department of Neurosciences, JUST Multisystem injuries associated Multisystem injuries associated with Head & Spine injuries Head Spine Chest 78% 10% Abdomen 53% 3% Cardiac 3% 2% musculoskeletal 43% 18% Spine 6% Head 16% Trauma Team Trauma Team General Surgeon Orthopedic Surgeon Vascular Surgeon Cardiothoracic surgeon Neurosurgeon Anesthesiologist Critical Care Trauma management protocol Trauma management protocol Start treatment before HX and P/E Primary survey ­Airway ­Breathing ­Circulation Secondary survey ­Hx & complete system by system exam ­X­rays (Chest, C­spine, Skeletal) ­CT (Brain, C­Spine, Chest, Abdomen) Initial Neurological Initial Neurological examination in head injury GCS Pupillary size and response to light Eye movements; ­Occulocephalic (dolls eyes) ­Oculovestibular (Caloric) Gross motor Gross sensory Head injury Head injury Glasgow coma score (GCS) ­Eye opening (E); Spontaneous=4, to voice=3, to pain=2, None=1 ­Verbal response (V); oriented=5, confused=4, inappropriate word=3, incomprehensive sounds=2, None=1 ­Motor response (M); Obeys command=6, localize pain=5, withdraw=4, flexion=3, extension=2, None=1 13­15 (mild), 9­12 (moderate), 3­8 (severe) Protocol for mild HI Protocol for mild HI (GCS 13­15) Initial work­up: ­History: (mechanism of injury, hx of L.O.C, HA, neck or back pain, seizures) ­Neurological exam ­Physical exam (R/O systemic injuries) ­Brain CT scan ­C­Spine Xray ­Blood alcohol level Protocol for mild HI Protocol for mild HI Admit to hospital: ­Significant amnesia ­Hx of L.O.C (> 5 minutes) ­Deteriorating L.O.C ­Significant Alcohol­drug intoxication ­Skull # ­CSF leak ­Significant associated systemic injuries ­No reliable companion at home ­Abnormal Brain CT. Discharge from ER if ­Patient does not meet the above criteria for admission ­Discuss the need to return if any problem developed (warning sheet) Moderate (GCS 9­12) and severe Moderate (GCS 9­12) and severe (GCS 3­8) HI Admit to hospital even with normal brain CT Mechanism of HI Mechanism of HI Closed; ­High velocity (auto accident) ­Low velocity (falls, assault) Penetrating; ­Gunshot wounds ­other open injuries Primary traumatic injuries Primary traumatic injuries Skull #; ­Linear ­Depressed ­basal skull Diffuse brain lesion; ­Brain concussion ­Diffuse axonal injury (DAI) Focal lesion; ­Epidural hematoma ­Subdural hematoma ­Intracerebral hgg ­brain contusion, laceration Management of traumatic HI Management of traumatic HI ABC Control ICP Treat specific lesion (epidural, subdural) Treat associated injuries Long term treatment for disabled patients ICP ICP Monro­Kellie doctrine rule Management Of Management Of High ICP ICP ICP Clinical cases Clinical cases Skull base fracture Depressed skull fractures Epidural hematoma Subdural hematoma ...
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