颅脑损伤(英文版)说课讲解课件

“Boy,do I have an Excedrin headache!”managing the head injured patientLeaugeay Webre BS,CCEMT-P,NREMT-P“Boy,do I have an Excedrin heScenarioWhile descending Mt Hood in Oregon,Bob tumbled head over heels,and came to a stop dangling off a precipice by his Telemark ski at 11,000 ft.On arrival the ski patrol paramedics Bobs breathing was sonorous and shallow,and he had a GCS of 3-4.The only obvious injuries were to his head.His BP was 87/55,HR 100 and RR 16ScenarioWhile descending Mt HoHow should the paramedics treat this patient?Should he be intubated?Should he be fluid resuscitated?How should the paramedics trCommon major trauma4 million people experience head trauma annuallySevere head injury is most frequent cause of trauma deathGSW to cranium:75-80%mortalityAt Risk populationMales 15-24InfantsYoung ChildrenElderlyIntroduction to Head,Facial,&Neck InjuriesCommon major traumaIntroductioTIME IS CRITICALIntracranial HemorrhageProgressing EdemaIncreased ICPCerebral HypoxiaPermanent DamageSeverity is difficult to recognizeSubtle signsImprove differential diagnosisImproves survivabilityIntroduction to Head,Facial,&Neck InjuriesTIME IS CRITICALIntroduction tScalpStrong Flexible mass ofSkinFasciaMuscular TissueHighly VascularHair provides InsulationStructures BeneathGalea AponeuroticaBetween scalp and skullFibrous connective sheathSubaponeurotica(Areolar)TissuePermits venous blood flow from the dural sinuses to the venous vessels of scalpEmissary Veins:Potential route for InfectionAnatomy&Physiology of the HeadScalpAnatomy&Physiology of ParietalSuture LineFrontalTemporalOrbitsMaxillaeMandibleTemporal Mandibular JointOcciptalNasal BonesZygomatic ArchSphenoidForamen Magnum(Hole in Base)ParietalSuture LineFrontalTemp颅脑损伤(英文版)说课讲解课件颅脑损伤(英文版)说课讲解课件BrainOccupies 80%of craniumComprised of 3 Major StructuresCerebrumCerebellumBrainstemHigh metabolic rateReceives 15%of cardiac outputConsumes 20%of bodys oxygenRequires constant circulationIF Blood supply stopsUnconscious within 10 secondsDeath in 4-6 minutesAnatomy&Physiology of the HeadBrainAnatomy&Physiology of Cerebral Perfusion PressurePressure within cranium(ICP)resists blood flow and good perfusion to the CNSPressure usually less than 10 mmHgMean Arterial Pressure(MAP)Must be at least 50 mmHg to ensure adequate perfusionMAP=DBP+1/3 Pulse PressureCerebral Perfusion Pressure(CPP)Pressure moving blood through the craniumCPP=MAP-ICPAnatomy&Physiology of the HeadCerebral Perfusion PressureAnaCalculating MAP(mean arterial pressure)DBP+1/3 PP PP(pulse pressure)=SBP-DBPSBP+2(DBP)3Calculating CPP(cerebral perfusion pressure)MAP ICPICP normally 90 systolicCPP=MAP-ICPMost important to keep MAP=/70HypotensionSingle most prognosHypotension in the face of cerebral edema results in decreased CPP(cerebral perfusion pressure)Hypotension in the face of cerMAP(2)DBP+SBP 3Normal(70-100)MAP(2)DBP+SBP HypoxiaDefined as SpO2 90%Leads to cell damage and resultant swellingClosely follows hypotension in influenceRSI faster and more reliableLess than 8 intubateHypoxiaDefined as SpO2 90Preferably Map 70 mm HGFluid of choice LR or NSGlucose causes fluid to be pulled into cells resulting in cerebral edemaFluid ResuscitationInitiate IVMonitorContinuously monitor VS for Sx of rising ICPChanges in breathing patternsIncreasing BPDecreasing HRUnequal pupilsPosturingMonitorContinuously monitor VSPositionElevated HOBMidline head placementAssists with venous drainage from the head which decreases ICPPositionElevated HOBHyperthermiaCauses an increase in ICP and should be regulatedHead injured patients often suffer from increased body temperatures and should be monitoredAcetaminophen and other cooling techniques may be used Do not induce hypothermia which may lead to shivering which results in increased ICPHyperthermiaCauses an increaseSeizuresIn the event of seizures treatment should be initiated immediately due to resultant hypoxia and increased ICPTreatment may include the use of Valium and CerebyxValium does not terminate abnormal electrical discharge as fosphenytoin doesPatients may need to be in an induced barbiturate comaSeizuresIn the event of seizurTreatment in HerniationHyperventilate to EtCo2 of no 95%Medications:OxygenPrimary 1sMedications:DiureticsMannitol(osmotrol)MOALarge glucose moleculeDoes not leave blood streamOsmotic DiureticEffective in drawing fluid from brainContraindicationHypovolemia&HypotensionCHFDose1gm/kgCAUTIONForms crystals at low temperaturesReconstitute with rewarming&gentle agitationUSE IN-LINE filter&PREFLUSH lineMedications:DiureticsMannitoMedications:DiureticsFurosemide(Lasix)MOALoop DiureticInhibits reabsorption of Na+in KidneysIncreased secretion of water and electrolytesNa+,Cl,Mg+,Ca+.Venous dilation&Reduces cardiac preloadMay be given in combination with MannitolNot effective in reducing cerebral edemaContraindicationPregnancy:fetal abnormalitiesDoseSlow IVP or IM over 1-2 minutes0.5-1 mg/kg:Commonly 40 or 80 mgMedications:DiureticsFurosemMedications:ParalyticsSuccinylcholine(Anectine)MOADepolarizing MedicationCauses FasciculationsOnset&DurationOnset:30-60 secondsDuration:2-3 minutesPrecautionParalyzes ALL muscles including those of respirationIncreases intraoccular eye pressureContraindicationPenetrating eye injury&DigitalisDose1-1.5 mg/kg IVConsider administration of defasiculating dose of paralyticUse with lidocaine 1mg/kg in head injured patientsMedications:ParalyticsSuccinMedications:ParalyticsPancuronium(Pavulon)MOANon-depolarizing agentDoes not affect LOCOnset&DurationOnset:3-5 minDuration:30-60 minDoseMust premed with sedative0.04-0.1 mg/kgVecuroniumVecuronium(Norcuron)(Norcuron)MOAMOA Non-depolarizing Non-depolarizing agentagent Does not affect LOCDoes not affect LOC Onset&DurationOnset&Duration Onset:1 minOnset:70 or SBP 90Orally intubate patients with GCS 8Hyperventilate only herniating injuries to EtCO2 to 30mmHGConclusionWe have the opportun