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2. Skull lesions
- Fractures of the vault (skull cap)
- Fractures of the skull base
MORFOPATHOLOGY II
It is completely reversible
Brain Contusion
BRAIN LACERATION
Epidural Hematoma
Accumulation of blood between duramater and internal board of skull dome
Source of bleeding may be arterial ( meningeal medium artery frequently), venous or from
fracture’s site
• Intraparenchymal Hematoma
Etiology CCT:
- aggression
- Accidents
- falls
- Accidents at work
To Avoid:
Objectives:
- Check airway
- Check breathing and ventilation efficiency
-evaluation of cardiocirculatory status (pulse, BP), making hemostasis,
put one or more IV lines
- Rx for thoraco-pulmonary pneumothorax and / or hemothorax
- Skull and cervical spine Rx + / - cervical collar
- Other urgent therapeutic measures (if necessary): chest drainage, blood
transfusion
To be Noted:
To be Noted:
- Vascular collapse in a patient with CCT may be due to:
- Major fractures
- Severe thoracic trauma
- Severe abdominal trauma
- Major arterial trauma
- Any patient with CCT presents risk of vomiting and aspiration
- Agitation of a patient with CCT may be due to brain damage but not
only by this, but also:
- Ingestion of alcohool
- hypoxia
- Bladder distension
- Administration of opioids, sedatives, muscular relaxants, hypnotics to a
patient with CCT before a complete clinical neurologic examination can
mask the clinical signs and symptoms
THERAPEUTICA L ATTITUDE VI
Objectives:
1. Maintaining adequate brain oxygenation
2. Maintaining adequate cerebral perfusion pressure
3. Prevention and reduction of neuroprotective cerebral edema
4. Neuroprotection
General measures:
1. Respiratory system:
- Maintaining Pa CO2 level to 30 mmHg
- Tracheobronchial aspiration
- Mechanical ventilation - when oxygen decreases by reducing
their respiratory effort
- If mechanical ventilation is required over seven days - is required
tracheostomy
- Monitoring of blood gases - important ellement in patient
assessment and treatment planning
THERAPEUTICA L ATTITUDE VII
2. Cardio-vascular System
- Avoid hyperhydration to CCT patients
- A moderate degree of hypertension is beneficial for nerve
structures and proper irrigation , so it will not be corrected
- Elevated BP can be avoided by appropriate treatment of pain, urinary
bladder distension, hypoxia, hypoglycemia
- The basic objective remains to maintain a proper CPP to avoid ischemia
2. Neuroprotection:
- Oxygen and maintain an appropriate CerebralPerfusionPressure
- Steroids - role of membrane stabilization
- Neurotropic substances: Piracetam, Meclofenoxat
- Vitamin C - role of free radicals fixative
- Vitamin B1 and B6 - important cofactors in neuronal energy
metabolism
THERAPEUTICA L ATTITUDE X