颅脑损伤（英文版).pptVIP

“Boy, do I have an Excedrin headache!!”managing the head injured patient Leaugeay Webre BS, CCEMT-P, NREMT-P Scenario While descending Mt Hood in Oregon, Bob tumbled head over heels, and came to a stop dangling off a precipice by his Telemark ski at 11,000 ft. On arrival the ski patrol paramedics Bob’s breathing was sonorous and shallow, and he had a GCS of 3-4. The only obvious injuries were to his head. His BP was 87/55, HR 100 and RR 16 Introduction to Head, Facial,  Neck Injuries 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 Introduction to Head, Facial,  Neck Injuries 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 Anatomy Physiology of the Head Scalp Strong Flexible mass of Skin Fascia Muscular Tissue Highly Vascular Hair provides Insulation Structures Beneath Galea Aponeurotica Between scalp and skull Fibrous connective sheath Subaponeurotica (Areolar) Tissue Permits venous blood flow from the dural sinuses to the venous vessels of scalp Emissary Veins: Potential route for Infection Anatomy Physiology of the Head 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 Anatomy Physiology of the Head 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 bl