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Open injuries
involve penetration of the scalp and skull (and usually the
meninges and underlying brain tissue)
typically involve bullets or sharp objects, but a skull fracture
with overlying laceration due to severe blunt force is also
considered an open injury.
Closed injuries
typically occur when the head is struck, strikes an object, or is
shaken violently, causing rapid brain acceleration and
deceleration
acceleration or deceleration can injure tissue at the point of
impact (coup), at its opposite pole (contrecoup), or diffusely; the
frontal and temporal lobes are particularly vulnerable
1. Concussion
Spontaneous 4
To Voice 3
Eye Opening
To Pain 2
None 1
Oriented 5
Confused 4
Best Verbal Inappropriate Words 3
Incomprehensible Sounds 2
None 1
Obeys Commands 6
Localizes Pain 5
Withdraws to Pain 4
Best Motor
Flexion to Pain 3
Extension to Pain 2
None 1
a. Traumatic Brain Injury
Area Assessed Infants Children Score*
No response No response 1
Verbal Coos and babbles Oriented, appropriate 5
response
Irritable cries Confused 4
Cries in response to pain Inappropriate words 3
Moans in response to pain Incomprehensible words or 2
nonspecific sounds
No response No response 1
a. Traumatic Brain Injury
Skull x-rays:
– It may be order to look for a fracture (break) in the skull bone.
– The presence of a skull fracture on x-ray does not mean there
has been an injury to the brain, and the absence of a fracture
does not exclude a brain injury.
– Skull x-rays are not taken as frequently now as in the past.
CT scan:
– Is the test used most often to evaluate acute head injuries.
– The CT is essentially an x-ray machine that takes multiple x-
rays from many angles around the head.
– A computer uses these x-ray images to make a picture of the
brain and other structures inside the skull.
– The details on a CT scan are very good, and even small spots
of blood may be seen as little white dots.
a. Traumatic Brain Injury
MRI scans:
– These are rarely used immediately after head injuries.
– The MRI may be used later for additional information about a
brain injury.
In some cases of bleeding in or around the brain,
angiography may be performed to visualize the blood
vessels.
– This test involves injecting dye into the arteries of the head.
– X-rays are taken that show the blood vessels and may show
exactly where bleeding is occurring.
– In some cases it is possible to stop the bleeding during
angiography. This involves injecting special materials, which are
released into the bleeding blood vessel and cause a clot to form.
If this procedure is successful, the bleeding is stopped without
the need for surgery.
a. Traumatic Brain Injury
Rehabilitation:
When neurologic deficits persist, rehabilitation is needed.
Occurrence and duration of coma after a TBI are strong predictors
of rehabilitation needs; of patients whose coma exceeds 24 h, 50%
have major persistent neurologic sequelae, and 2 to 6% remain in
a persistent vegetative state at 6 mo.
For patients who survive the initial hospitalization, a prolonged
period of rehabilitation, particularly in cognitive and emotional
areas, is often required, and rehabilitation services should be
planned early.
Rehabilitation is best provided through a team approach that
combines physical, occupational, and speech therapy; skill-building
activities; and counseling to meet the patient's social and
emotional needs.
b. Temporal Bone Fractures
Liver Injury
Spleen Injury
Kidney Injury
Bowel Rupture
Pancreas Injury
Assessment of abdominal trauma
Imaging
Either CT or ultrasound can be used for the
assessment of abdominal trauma
CT scanning is preferred method but
requires patient to be cardiovascularly stable
Ultrasound has high specificity but low
sensitivity for the detection of:
– Free fluid
– Visceral damage
Assessment and Diagnostic Findings
FAST
Focused assessment for the sonographic assessment
of trauma
Is the use of ultrasound to rapidly assess for
intraperitoneal fluid
Probe is placed on the:
– Right upper quadrant
– Left upper quadrant
– Suprapubic region
Fluid in subphrenic, subhepatic spaces or Pouch of
Douglas in hypotensive patient
Confirms likely need for emergency laparotomy
Assessment and Diagnostic Findings
Peritoneal lavage
– Indications
Equivocal clinical examination
Difficulty in assessing patient
Persistent hypotension despite adequate
resuscitation
Multiple injuries
Stab wounds where the peritoneum has been
breached
Assessment and Diagnostic Findings
Peritoneal lavage
– Method
Ensure that a catheter and nasogastric tube is in place
Incise peritoneum and insert peritoneal dialysis catheter
Aspirate any free blood or gastric content
If no blood seen - infuse 1litre of normal saline an allow 3
min. to equilibrate
Place drainage bag on floor and allow to drain
Send 20 ml to laboratory for measurement of RBC, WBC
and microbiological examination
Assessment and Diagnostic Findings
Peritoneal lavage
– Positive result
Red cell count more than 100,000 /
mm3
White cell count more than 500 / mm3
Presence of bile, bacteria or fecal
material
Nursing/ Medical Management
Initial operation
Early management of major abdominal
trauma surgery should aim to:
– Control hemorrhage with ligation of vessels and
packing
– Remove dead tissue
– Control contamination with clamps and stapling
devices
– Lavage the abdominal cavity
– Close the abdomen without tension
Nursing/ Medical Management
Definition
Dental trauma is injury to the mouth, including
teeth, lips, gums, tongue, and jawbones. The most
common dental trauma is a broken or lost tooth.
Description
– Dental trauma may be inflicted in a number of ways:
contact sports, motor vehicle accidents, fights, falls,
eating hard foods, drinking hot liquids, and other
such mishaps.
– As oral tissues are highly sensitive, injuries to the
mouth are typically very painful. Dental trauma
should receive prompt treatment from a dentist.
III. DENTAL TRAUMA
III. DENTAL TRAUMA
Diagnosis
– Dental trauma is readily apparent upon
examination.
– Dental x rays may be taken to determine
the extent of the damage to broken teeth.
More comprehensive x rays are needed to
diagnose a broken jaw.
III. DENTAL TRAUMA
Treatment
– Soft tissue injuries may require only cold
compresses to reduce swelling.
– Bleeding may be controlled with direct pressure
applied with clean gauze.
– Deep lacerations and punctures may require
stitches.
– Pain may be managed with aspirin or
acetaminophen (Tylenol, Aspirin Free Excedrin)
or ibuprofen (Motrin, Advil).
III. DENTAL TRAUMA