1. FOR TRAUMA, KNOW THE DIFFERENT CATEGORIES OF:
a. Brain Trauma:
i. Brain Trauma: not usually direct injury to brain tissue; can occur from external forces applied to the
exterior of skull or movement of the brain in
...
1. FOR TRAUMA, KNOW THE DIFFERENT CATEGORIES OF:
a. Brain Trauma:
i. Brain Trauma: not usually direct injury to brain tissue; can occur from external forces applied to the
exterior of skull or movement of the brain inside the skull (coup/contrecoup, concussion).
ii. Coup: bruising at direct area of impact
iii. Contrecoup: cranial contents shift, temporal or posterior region
iv. Mechanism of injury: acceleration-deceleration (coup-contrecoup) where rapid acceleration of head hits
directly then cranial contents stop and shift then decelerate (diffuse injury) and deformation where
depresses thickness of skull and cause damage to brain tissue
v. Types of trauma:
1. Blunt: hit something direct
2. Penetrating: penetrates into brain tissue
3. High (GSW) vs. low (hit with a hammer) velocity objects
4. Coup/contrecoup injury (fall or hit dashboard in MVC)
vi. Primary head injury
1. This is injury patient presents with, trying to prevent secondary injuries
2. Scalp Injuries (1st line of defense):
a. Laceration: most common, get good HPI & ask when their last tetanus shot was
b. Will see profuse bleeding bc scalp has great vascular supply. Can apply direct pressure to
control the bleeding IF there is no underlying skull fx. (pressure worsens fx)
c. Monitor for s/s of hypovolemia: hypotension, & shock: tachycardia, decreased uop, AMS).
d. Exam lac & thoroughly clean before suturing. Use suture for face, staples ok for skull.
vii. Skull Fracture:
1. Simple: No displacement of bone; require no specific tx.
2. Depressed: Bone fragment depressed into skull
a. Asymptomatic, possible altered LOC.
b. Prophylactic abx (include tetanus toxoid if needed)
c. Seizure precautions & consult neurosurgery
3. Compound: bone depressed in and parts sticking out
4. Penetrating Fracture: object penetrating into the skul
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