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Initial management of patients is based on the ABC approach to emergency medicine
- Open the Airway
- Access Breathing
- Check Circulation
Most patients will arrive to the ER comatose. This state is one of ocmplete paralysis of cerebral functioin, or complete unresponsiveness. This is the first of five phases of recovery:
- 1) The absence of verbal and motor response, absence of spontaneous eye opening, reflexive eye movements, hyperactive deep tendon reflexes, and decorticate or decerebrate posturing.
- 2)The pt. is semi comatose and begins to withdraw from painful stimuli.
- 3)The pt. is restless, and responds to simple commands.
- 4)The pt. responses are disoriented and confused.
- 5)The pt. has orientation, carryover, and insight. All recovery is dependent on the severity of trauma.
Skull fractures (Linear or Comminuted)
Usually reslut from low-velocity objects; whereas, depressed skull fractures result from high-velocity objects. They produce contusions, laceration, cranial nerve damage and a decrease in cranial activity. Depending upon impact there may or may not be subsequent brain damage.
Closed Head Injuries
occur without a fracture. It can be a minor injury or profound and irreversible. Damage fro this injury includes brainstem involvement, contusion, diffuse matter lesions, blood vessel damage, and cranial damage
Open Head injuries
are the result of compound, depressed skull fractures. Concussions are the most minor brain injury. It is a temporary or permanent loss of consciousness and implies impaired function of the reticular activating system.
usually result from and acute hemorrhage in the subdural space cause by a rupture. They can develop within a week after injury, but could evolve in hours. Approximately 50% are associated w/ skull fractures w/ motor vehicle accidents being the most common cause.
include gunshot wounds, blows to the neck, and injuries to the face or cervical hyperextension
Two types of amnesia can occur in a head injury
the inability to recall memories of known past experiences before the injury
- loss of memory for events between the injury and ongoing events
- (What was for breakfast? What happened yesterday?)