颅脑损伤（英文版)培训资料.ppt

“Boy, do I have an Excedrin headache!!”managing the head injured patient;Scenario; ;Common major trauma 4 million people experience head trauma annually Severe head injury is most frequent cause of trauma death GSW to cranium: 75-80% mortality At Risk population Males 15-24 Infants Young Children Elderly;TIME IS CRITICAL Intracranial Hemorrhage Progressing Edema Increased ICP Cerebral Hypoxia Permanent Damage Severity is difficult to recognize Subtle signs Improve differential diagnosis Improves survivability;Brain Occupies 80% of cranium Comprised of 3 Major Structures Cerebrum Cerebellum Brainstem High metabolic rate Receives 15% of cardiac output Consumes 20% of body’s oxygen Requires constant circulation IF Blood supply stops Unconscious within 10 seconds Death in 4-6 minutes;Cerebral Perfusion Pressure Pressure within cranium (ICP) resists blood flow and good perfusion to the CNS Pressure usually less than 10 mmHg Mean Arterial Pressure (MAP) Must be at least 50 mmHg to ensure adequate perfusion MAP = DBP + 1/3 Pulse Pressure Cerebral Perfusion Pressure (CPP) Pressure moving blood through the cranium CPP = MAP - ICP;Calculating MAP (mean arterial pressure) DBP + 1/3 PP PP (pulse pressure) = SBP - DBP SBP + 2(DBP) 3 Calculating CPP (cerebral perfusion pressure) MAP – ICP ICP normally 10 ;Cerebral Perfusion Pressure Autoregulation Changes in ICP result in compensation Increased ICP = Increased BP This causes ICP to rise higher and BP to rise Brain injury and death become imminent Expanding mass inside cranial vault Displaces CSF If pressure increases, brain tissue is displaced;Face Muscles;Types of Trauma; The patient presented to the emergency department with the golf cub in his head, which was removed in the operating room ;Lateral skull x-ray of a patient who presented with a severe intracranial injury produced by a golf club;Scalp Injury;Brain Injury;Direct Brain Injury Types;Intracranial Perfusion;Intracranial Perfusion;Intracranial Pressure;Factors Af