颅脑损伤(英文版)复习进程.ppt

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1、“Boy,doIhaveanExcedrinheadache!!”managingtheheadinjuredpatientLeaugeayWebreBS,CCEMT-P,NREMT-PScenarioWhiledescendingMtHoodinOregon,Bobtumbledheadoverheels,andcametoastopdanglingoffaprecipicebyhisTelemarkskiat11,000ft.OnarrivaltheskipatrolparamedicsBob’sbreathingwassonorousan

2、dshallow,andhehadaGCSof3-4.Theonlyobviousinjuriesweretohishead.HisBPwas87/55,HR100andRR16Howshouldtheparamedicstreatthispatient?Shouldhebeintubated?Shouldhebefluidresuscitated?Commonmajortrauma4millionpeopleexperienceheadtraumaannuallySevereheadinjuryismostfrequentcauseoftrau

3、madeathGSWtocranium:75-80%mortalityAtRiskpopulationMales15-24InfantsYoungChildrenElderlyIntroductiontoHead,Facial,&NeckInjuriesTIMEISCRITICALIntracranialHemorrhageProgressingEdemaIncreasedICPCerebralHypoxiaPermanentDamageSeverityisdifficulttorecognizeSubtlesignsImprovediffer

4、entialdiagnosisImprovessurvivabilityIntroductiontoHead,Facial,&NeckInjuriesScalpStrongFlexiblemassofSkinFasciaMuscularTissueHighlyVascularHairprovidesInsulationStructuresBeneathGaleaAponeuroticaBetweenscalpandskullFibrousconnectivesheathSubaponeurotica(Areolar)TissuePermitsv

5、enousbloodflowfromtheduralsinusestothevenousvesselsofscalpEmissaryVeins:PotentialrouteforInfectionAnatomy&PhysiologyoftheHeadParietalSutureLineFrontalTemporalOrbitsMaxillaeMandibleTemporalMandibularJointOcciptalNasalBonesZygomaticArchSphenoidForamenMagnum(HoleinBase)CraniumB

6、rainOccupies80%ofcraniumComprisedof3MajorStructuresCerebrumCerebellumBrainstemHighmetabolicrateReceives15%ofcardiacoutputConsumes20%ofbody’soxygenRequiresconstantcirculationIFBloodsupplystopsUnconsciouswithin10secondsDeathin4-6minutesAnatomy&PhysiologyoftheHeadCerebralPerfus

7、ionPressurePressurewithincranium(ICP)resistsbloodflowandgoodperfusiontotheCNSPressureusuallylessthan10mmHgMeanArterialPressure(MAP)Mustbeatleast50mmHgtoensureadequateperfusionMAP=DBP+1/3PulsePressureCerebralPerfusionPressure(CPP)PressuremovingbloodthroughthecraniumCPP=MAP-ICP

8、Anatomy&PhysiologyoftheHeadCalculatingMAP(meanarterialpressure)DBP+