HEAD INJURY AND
TRAUMA RESUSCITATION
ABDIRAHMAN .D. WAIS ( ANESTHETIST,MPH)
Objectives
Demonstrate concepts of primary and
secondary patient assessment
Establish management priorities in trauma
situations
Initiate primary and secondary management
as necessary
Arrange appropriate disposition
Introduction
Trauma: (Greek) an injury to living tissue
caused by an extrinsic agent.
Blunt (majority)
Penetrating
Thermal
Chemical
Ionizing radiation
Nuclear radiation
etc.
Con,t
Mechanisms of Injury
HEAD INJURY
HI can be from blunt or penetrating trauma
Indirect injury can be caused by the
movement of the brain within the skull.
Primary injury:
– At time of injury
Secondary injury:
– Minutes to days after due to neurophysiological
and anatomical changes such as cerebral
oedema, haematoma or raised ICP
Other types of head injury.
Scalp lacerations: can bleed profusely.
Skull fractures eg linear, simple,
communited, depressed, closed or open.
Base of skull fracture: CSF out of the ears,
nose, battle sign, raccoon eyes. May
complicate to meningitis.
Other types of head injury
Concussion: temporary loss of neurological
functioning with no apparent structural
damage. May or may not have loss of
consciousness. May have amnesia.
Contusion: moderate to severe head injury,
bruise. Impact of the brain against the skull.
Loss of consciousness(associated with
confusion).
Signs Basal Skull fracture
Signs of basal skull fracture:
– haemotoma
– 'panda' eyes (bruising around the eyes),
– CSF leakage (ears or nose)
– Battle's sign (bruising which sometimes occurs
behind the ear in cases of basal skull fracture)
Complications of head injury
Raised ICP
Cerebral herniation
CSF leak
Meningitis
Intracranial haemorrhage
Extracranialhaemorrhage
Seizures
Preparation
Care team
Surgeon
Medical
Attending Anesthetics
Pharmacist
Operating room nurses
Pathology
THE CARE TEAM IN ACTION
Trauma Team
Primary Survey
Patients are assessed and treatment
priorities established based on their injuries,
vital signs, and injury mechanisms
ABCDEs of trauma care
– A Airway and c-spine protection
– B Breathing and ventilation
– C Circulation with hemorrhage control
– D Disability/Neurologic status
– E Exposure/Environmental control
A- Airway
Airway should be assessed for patency
– Is the patient able to communicate verbally?
– Inspect for any foreign bodies
– Examine for stridor, hoarseness, gurgling, pooled
secrecretions or blood
Assume c-spine injury in patients with
multisystem trauma
– C-spine clearance is both clinical and radiographic
– C-collar should remain in place until patient can
cooperate with clinical exam
Airway Interventions
Supplemental oxygen
Suction
Chin lift/jaw thrust
Oral/nasal airways
Definitive airways
Difficult Airway
B- Breathing
Airway patency alone does not ensure
adequate ventilation
Inspect, palpate, and auscultation
– Deviated trachea, flail chest, sucking chest
wound, absence of breath sounds
CXR to evaluate lung fields
Breathing Interventions
observe chest movement, listen to breath
sounds
Ventilate with 100% oxygen
C- Circulation
Hemorrhagic shock should be assumed in
any hypotensive trauma patient
Rapid assessment of hemodynamic status
– Level of consciousness
– Skin color
– Pulses in four extremities
– Blood pressure and pulse pressure
Circulation Interventions
Apply pressure to sites of external hemorrhage
Establish IV access
– 2 large bore IVs
– Central lines if indicated
Volume resuscitation
– Have blood ready if needed
– Level One infusers available
– Foley catheter to monitor resuscitation
D- Disability
Abbreviated neurological exam
– Level of consciousness
– Pupil size and reactivity
– Motor function
– GCS
» Utilized to determine severity of injury
» Guide for urgency of head CT and ICP monitoring
E- Exposure
remove all clothing
Warm blankets/external warming device to
prevent hypothermia
Secondary Survey
Key Components
History
Physical examination: Head-to-toe
Complete neuro exam
Special diagnostic tests
Re-evaluation
Secondary Survey
History
A Allergies
M Medications
P Past illnesses
L Last meal
E Events / Environment
GCS
EYE VERBAL MOTOR
Spontaneous 4 Oriented 5 Obeys 6
Verbal 3 Confused 4 Localizes 5
Pain 2 Words 3 widrowal 4
None 1 Sounds 2 Decorticate 3
None 1 Decerebrate 2
None 1
Total normal
maximum score 15/15
Total minimum score 3/15
Treatment
GOALS
Secure the airway
Ventilation and oxygenation
Maintenance of hemodynamics
Maintain organ perfusion
Coagulation
Achieve end point(s) of resuscitation
AIRWAY MANAGEMENT
All airway management must be performed with
c-spine immobilization unless c-spine stability is
confirmed by radiologic exam and cleared by the
caregiver
Administer oxygen by mask
Suction as required
Remove foreign bodies
Chin lift or jaw thrust with second caregiver
providing c-spine stabilization
AIRWAY MANAGEMENT
If patient is unresponsive but spontaneously
breathing use oral or nasal airway, unless
suspected nasal trauma, until patient can be
intubated.
When it is determined that intubation should be
performed, no other procedures should occur
while the intubation is being attempted. All
members of the trauma team should focus on the
intubation.
AIRWAY MANAGEMENT
All equipment should be prepared and
checked (with backup available) before any
airway manipulation is attempted. Effective
suction is a must.
Plan B,C,D and E must be available and
rehearsed .
Thanks for the attention
and listening