Head and Other Injuries PDF

Head, spine, chest and abdominal injuries Piotr Szwedziński 1 Head injuries 2  Head injuries Cause of death in 25% of trauma patients Cause of death in 50% of road accidents Significantly long peri...

Head, spine, chest and abdominal injuries Piotr Szwedziński 1 Head injuries 2  Head injuries Cause of death in 25% of trauma patients Cause of death in 50% of road accidents Significantly long period of disability Early diagnosis and treatment can improve treatment outcomes All patients with head and facial trauma have cervical spine injury unless this has been ruled out 3  Head injuries: -Skin wounds -Skull fractures (cracks, intrusions, compound fractures) -Brain injuries(concussion, contusion, diffuse axonal damage, damage due to hypoxia, intracranial bleeding) 4 Skin wounds 5  Symptoms of a basilar skull fracture: bruising behind the ears and bruising around the eyes 6  Brain injuries Concussion: -Up to 24 hours after injury, no structural brain disorders, short-term loss of consciousness, dizziness, amnesia of the period of injury, vomiting. Contusion: -Prolonged loss of consciousness, serious disturbances of consciousness, inappropriate behavior, "stroke symptoms", cerebral edema may occur. Diffuse axonal changes: -The brain damage is so extensive that it leads to generalized cerebral edema and subarachnoid hemorrhage. The blood in the subarachnoid space causes tissue irritation and fluid leakage outside the vessels – edema occurs. -Seizures, coma, vomiting. 7  Brain injuries Damage due to hypoxia: -Cerebral hypoxia, cardiac arrest, airway obstruction Intracranial bleeding: -Epidural bleeding -Subdural bleeding -Intracranial bleeding 8  Head injuries Symptoms: - Confusion, agitation, aggression, - Retrograde amnesia, disorientation, drowsiness, - Disturbances of consciousness - Incoherent speech, headache and dizziness, - Nausea and vomiting 9 Spinal injuries 10 Anatomy of a vertebra Spinal Transverse cord process Spinous process Circle 11  Blunt spinal injuries - Excessive deflection - Excessive bending - Compression - Rotation - Stretch - Tear 12  Spinal cord injuries Original spinal cord injury §The damage is immediate and irreversible §Spinal cord it stays cut , torn , crushed or loses tributary blood Secondary spinal cord injury §Trauma core is developing myself later because of : - Hypoxia , edema , hypotension arterial , pressure From swelling or bleeding around core - Correct treatment of the injured party it should minimize trauma secondary 13  Spinal injuries When to suspect: - Blunt trauma above the collarbones - Victims of road accidents - People who fell from a height - After jumping into the water, people who attempted suicide by hanging - Electrocuted - Unconscious after injury, injury above the shoulder line 14  Spinal injuries Symptoms: - Sensory disturbances (below the injury) - Paresis or paralysis of the limbs - Breathing disorders - Pain at the site of a spinal injury - Warm pink skin - Paralysis of the sphincter muscles 15 Chest injuries 16  Chest injuries - Respiratory obstruction - Open pneumothorax - Tension pneumothorax - Massive hemothorax - Flail chest - Pericardial tamponade 17  Chest injuries Symptoms: - Bruises or palpable fractures - Pain when breathing - Shortness of breath, - Cyanosis, weak pulse on the radial artery - Disturbances of mobility of the chest walls - Distention or collapse of the external jugular veins - Tracheal displacement - Coughing up blood 18  Chest injuries Open pneumothorax: puncture of the chest wall and leaving a wound communicating with the pleural cavity. As a result of the increase in pressure in the pleural cavity, the lung collapses. 19  Open pneumothorax - Assess the condition of the injured person - Give me oxygen. - Ensure thermal comfort - Call for urgent medical help - Provide psychological care - Secure the chest wound with a ventilated dressing. - Asherman's dressing - a sterile piece of foil glued only on 3 sides - Systematically assess the injured person 20 Open pneumothorax 21  Chest injuries Tension pneumothorax: air during inspiration enters the pleural cavity. With each subsequent inspiration, another portion of gases enters this closed space, increasing the pressure in the pleural cavity and impairing the expansion of the lung. Advanced pneumothorax causes pressure on the healthy lung, impairing its function. 22  Tension pneumothorax - Increasing shortness of breath and cyanosis; - Anxiety, agitation; - Jugular vein dilatation - Tracheal displacement - Developing shock - Possible subcutaneous emphysema. 23  Chest injuries Massive hemothorax: It occurs as a result of damage to the intercostal vessels, lung parenchyma by a broken fragment of a rib or as a result of damage by an open trauma (wound) to the chest. The pleural cavity can contain a large amount of blood (30%-40% of the circulating blood volume). 24  Massive hemothorax Symptoms: - Trachea in the midline - Collapsed jugular veins - Acceleration of heart rate - Cyanosis - Developing shock - Respiratory disturbances and shortness of breath – late. 25  Chest injuries Flail chest: Fracture of three or more adjacent ribs in at least two places. 26  Chest injuries Cardiac tamponade: A condition in which blood enters the pericardial cavity, making it difficult for the heart chambers to fill with blood during diastole. 27  Cardiac tamponade Symptoms: - Trachea in the midline - Filled external jugular veins - Symmetrical respiratory movements of the thoracic section - Acceleration of heart rate - Pulse rate drops during inhalation - Developing shock 28 Abdominal injuries 29  Anatomy The abdomen can be divided into 3 areas. The upper and lower levels of the abdominal cavity and the retroperitoneal space. 30  Anatomy The upper abdominal cavity is located between the diaphragm and the costal arch. The liver, gallbladder, spleen, stomach and duodenum are located within it. The lower abdominal cavity is located below the rib arches. It includes: the small intestine, the large intestine, part of the liver, and the urinary bladder. In women, there is also the uterus, fallopian tubes and ovaries. 31  Anatomy The retroperitoneal space is separated from the peritoneal cavity by the parietal peritoneum. It includes the kidneys, ureters, pancreas, abdominal aorta and inferior vena cava. 32  Abdominal injuries Blunt: These are the most common abdominal injuries. The mechanism of this type of injury is crushing, which causes rupture of parenchymal organs (liver, spleen, kidneys) or rupture of cavernous organs (stomach, duodenum, intestines). Mortality rate 10-30% - Internal bleeding may be very heavy Early onset of symptoms suggests serious injury 33  Abdominal injuries Penetrating: Most of these injuries are stab or gunshot wounds. Gunshot wounds - High mortality (up to 15%) as a result of extensive damage to internal organs – Stab wounds - Mortality rate 1-2% - Stab wounds to the chest may penetrate into the abdomen and vice versa. 34  Abdominal injuries Gastroschisis: Exstrophy of the contents of the abdominal cavity through the damaged integuments to the outside. Cover the eviscerated organs with a moist, sterile and impermeable dressing to protect against drying out. Don't try to put them back in 35  Abdominal injuries Body positioning in abdominal injuries: Lying position with legs bent at the hip and knee joints 36 Thank you for your attention 37