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Head Injuries. Case Study of Allen NOTE: THERE ARE ANSWERS TO 2 CASE STUDIES HERE. I THINK YOU ONLY GOT ONE IN CLASS!!!!!. What initial measures should be taken?. Airway patency Protect cervical spine Any others?. What type of head trauma do you suspect?. Contusion Concussion

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head injuries

Head Injuries

Case Study of Allen

NOTE: THERE ARE ANSWERS TO 2 CASE STUDIES HERE.

I THINK YOU ONLY GOT ONE IN CLASS!!!!!

slide3
Airway patency
  • Protect cervical spine
  • Any others?
slide5
Contusion
  • Concussion
  • Skull fracture
slide7
Skull x-rays
  • CT or MRI of head
  • ABG’s
  • Cervical spine x-rays
  • Basic CMP and CBC
slide9
LOC
  • VS
  • Bleeding from cut
  • Check O2 sats
  • Watch for loss of clear liquid from nose or ears
  • Battles’s sign
  • Raccoon eyes
slide11
Parents decide…he is a minor
  • Call chaplain or counselor
slide13
Could be drug or alcohol usage
  • Most likely a subdural hematoma
slide15
CT of head
  • Drug screen
  • CBC, BMP, ABG’s
slide19
Glasgow coma scale
  • VS
  • LOC
  • Watch for drainage of wound or from ears or nose
slide21
Look for halo or ring
  • Document color, amount and appearance
  • Can test liquid for glucose but not reliable
slide29
1. Are these blood gases acceptable?

What is happening?

What ventilator changes?

slide30
CO2 is high and pH is low
  • Increase vent rate to get rid of CO2 (hyperventilate)
  • What will high CO2 do?
slide34
HOB up 30 degrees
  • Knees straight
  • Head in alignment
slide36
Battles’s sign-basilar skull fracture
  • Look for rhinorrhea and otorrhea
  • High risk for infection
  • May develop hematoma
slide37
ICP is 25
  • BP = 90/30
  • CPP?
slide38
CPP=MAP-ICP.
  • MAP=DBP + 1/3 (SBP-DBP)
  • MAP=30+ (90-30)

3

slide40
Could cause ischemia
  • Raise MAP and lower ICP
  • Check IV fluids, use of diuretics or dopamine
  • Surgery?
  • HOB and body position good?