1. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S AER-HEAD TRAUMA (SKULL AND BRAIN) TETANUS MANAGEMENT14 - September - 2012Prepared By Dr Gamal Soliman1

2. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S AHEAD TRAUMA-DEFINITION Head injury can result from direct or indirect impact that causes the brain to move forward, rebound backward, or rotate against the rigid, irregular surface of the skull. Most frequently seen in motor vehicle accidents, head trauma is also a common finding following falls, seizures intoxication, and physical assault.14 - September - 2012Prepared By Dr Gamal Soliman2 3. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S AOBJECTIVE 1. To provide immediate care to the patient 2. To prevent further trauma 3. To prevent complications14 - September - 2012Prepared By Dr Gamal Soliman3 4. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A POLICY 1. Brain injury is classified as: 1.1 Concussion maybe so mild that the patient is unaware of the injury, the patient may complain of headache, dizziness or nausea. Contusion can occur with closed head injury when the forced of the blow is great enough to rupture blood vessels found in the surface of or deep within the brain. Direct can occur in open head injury with brain being lacerated, punctured or bruised by broken bones of the skull. 14 - September - 2012Prepared By Dr Gamal Soliman4 5. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A2. Skull injuries are classified as: 2.1 Skull fractures 2.1.1 Linear skull fracture, thin line crack in the cranium 2.1.2 Comminuted skull fracture 2.1.3 Depressed skull fracture bone fragments 2.1.4 Basal skull fracture. 2.2 Facial fractures- usually produced by an impact. 14 - September - 2012Prepared By Dr Gamal Soliman5 6. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A3. Patients with head injuries require immediate assessment for prompt and rapid treatment and management. 4. Stabilization of airway is the first priority for patients with head injury.14 - September - 2012Prepared By Dr Gamal Soliman6 7. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A5. For cervical spinal injury, head and neck immobilization had to be maintained. 6. Head trauma patients are assessed for the presence of 6.1 Ineffective airway clearance from secretions and vomitus. 6.2 Ineffective breathing pattern. 6.3 Alteration in sensory perception and though process due to injury.:14 - September - 2012Prepared By Dr Gamal Soliman7 8. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A7. Oxygen is administered immediately and vital signs are obtained and monitored including neurological assessment. (Glasgow Coma Scale). 8. Fluid administration is initiated and intake and output is measured to prevent excess fluid administration. 9. Bleeding is controlled and medications started as ordered.10. Blood is obtained for baseline laboratory analysis, and x-rays for any signs or cervical trauma.14 - September - 2012Prepared By Dr Gamal Soliman8 9. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S AMATERIALS & EQUIPMENT 1. Oxygen- cannula /mask 2. Gauze dressing/ pressure dressing pads 3. Suction machine 4. IV fluids and medications as prescribed14 - September - 2012Prepared By Dr Gamal Soliman9 10. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S APROCEDURE RATIONALE 1. Monitor and assess neurologic and vital signs frequently as ordered. 1. For prevention, early recognition, and prompt treatment14 - September - 2012Prepared By Dr Gamal Soliman10 11. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S Acomplications. 2. Stabilize the airway: 2. Inability to effectively clear the airway may results in anoxia, hypercapnea, and aspiration. 3. Place the patient in a safe and comfortable position. 3. To protect from injury. 4. Talk to the patient, if conscious 4. Helps detects changes in level of consciousness. 14 - September - 2012Prepared By Dr Gamal Soliman11 12. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A 5. Provide IV access for: 5.1 IV fluid administration 5.2 IV medications 5.3 Blood samples14 - September - 2012Prepared By Dr Gamal Soliman12 13. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A6. Administer Oxygen, obtains ABG 6. To prevent hypoxia and assess for respiratory compromise. 7. Control bleeding by: 7.1 Do not apply pressure if the injury sites shows bone fragment or depression of bone or if brain is exposed. 7.2 Do not attempt to stop the flow of blood or CSF from the ears or nose.14 - September - 2012Prepared By Dr Gamal Soliman13 14. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S APROCEDURE RATIONALE1.414 - September - 20121.2 Breathing 1.3 Circulation Vital signs should receive high flow, humidified oxygen (100%).Prepared By Dr Gamal Soliman14 15. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S ATETANUS14 - September - 2012Prepared By Dr Gamal Soliman15 16. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S ADEFINITION Tetanus is a clinical syndrome caused by the release of a potent neurotoxin produced by clostridium tetani.14 - September - 2012Prepared By Dr Gamal Soliman16 17. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S AOBJECTIVE 1. To prevent hypoxia. 2. To prevent and treat convulsions. 3. To protect the patient from injury.14 - September - 2012Prepared By Dr Gamal Soliman17 18. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A POLICY 1. Assessment of patient includes: 1.1 Lockjaw (stiffness of the jaw). 1.2 Convulsions, twitching 1.3 Difficulty of swallowing. 1.4 Excessive yawning 1.5 Muscle spasms 1.5 Opisthotonus (extreme arching of the back and retraction of the head14 - September - 2012Prepared By Dr Gamal Soliman18 19. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A3. The patient shoule be placed in a quiet and dark room a possible to avoid triggering spasms. 4. Airway and breathing pattern are maintained.14 - September - 2012Prepared By Dr Gamal Soliman19 20. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A5. Oxygen administration and endotracheal intubation6. Positioned properly to facilitate drainage of oral secretions. 7. Tetanus immunization immediately,8. All patients with generalized tetanus need immediate critical care. 9. Vital signs are taken and recorded frequently.14 - September - 2012Prepared By Dr Gamal Soliman20 21. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S APROCEDURE RATIONALE 1. Assess patient for: 1.1 Stiffness of the jaw 1.2 Convulsions, twitching 1.3 Difficulty of swallowing 1.4 Excessive yawning 1.5 Muscle spasm14 - September - 2012Prepared By Dr Gamal Soliman21 22. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S AProvide intravenoud access 6.1 I.V. fluids 6.2 Medications anti-convulsants 6.2 To treat convulsions. 14 - September - 2012Prepared By Dr Gamal Soliman22 23. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A PROCEDURE RATIONALE 7. Raise up side rails and stay with the patient. 7. To protect from injury. 8. Administer tetanus vaccine. 8. For tetanus 8.4 Tetanus immunoglobulin 8.5 dTT (diptheria tetanus toxoid) 9. Encourage the patient to complete his immunization. 14 - September - 2012Prepared By Dr Gamal Soliman23 24. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A10. Monitor vital signs frequently and report any abnormality. 10. The patient initially have a low-grade fever. 11. Expedite admission, if required. 14 - September - 2012Prepared By Dr Gamal Soliman24