728x90 신경외과/Trauma5 Temporal bone fracture (측두부 골절) longitudinal transverse incidence 80% 20% Direction to petrous bone parallel perpendicular impact Temporal or parietal occipitomastoid Otic capsule sparing disrupting Ear bleeding or otorrhea common Less common 7th nerve Facial paralysis(20%) delayed onset, good prognosis Facial paralysis(50%) delayed onset, poor prognosis 8th nerve Conductive hearing loss Sensory nerve hearing loss hemotynpanum.. 2021. 1. 6. Traumatic brain injury SECONDARY INJURY PROCESSES Hypoxia-ischemia Edema Excitotoxicity Calcium dysregulation Apoptosis Cytoskeletal proteolysis Metabolic and mitochondrial derangements Oxidative stress Inflammation Calcium Dysregulation TBI always leads to intracellular influx of calcium Unregulated calcium influx Overwhelming the mitochondrial capacity Activating various enzymes Cysteine proteases(calpain, caspase, .. 2021. 1. 3. Brain herniation Cerebral Herniation Syndromes - Cingulate Herniation If one hemisphere is forced under the falx, the cingulate lobe is the first portion of that hemisphere to be displaced confused and drowsy The anterior cerebral artery territory infarct leading to contralateral lower extremity weakness and urinary incontinence - Uncal Herniation The most common clinically significant traumatic herniation syndr.. 2021. 1. 3. Brain injury, hemorrhage Op indication Management Options for Traumatic Hemorrhagic Lesions Condition Management Subdural Hematoma >10 mm thick or >5 mm midline shift Surgical evacuation ICP >20 mm Hg Surgical evacuation GCS score 30 mL volume, regardless of GCS score Surgical evacuation GCS score >8 without focal neurological deficit Conservative management with intensive monitoring and serial imaging Intraparenchymal Hematoma Progr.. 2020. 12. 31. 외상환자 관련 0) 초진환자 응급실 내원환자 전신 손상의심(자전거, 오토바이, 추락 등) -> 반드시 흉부, 복부 검사 시행 CT (Chest, Abdomen-pevis) X-ray (Chest, Abdomen, Pelvis) 의식저하나 중증환자의 경우 가급적 T_bay로 이동 의식이 명료한 경우 (특히 chronic SDH) NPO time확인 T-bay 내원환자 외상보다 의식소실이 먼저인게 확인된 경우 -> CT angio GCS < 9, 개방성 뇌손상, 두개골 기저부의 심한손상시 (또는 심한 안면 손상) CT angio 1) 초기 외상 소생술 Airway – Intubation 이 필요하다고 판단되면, 즉시 시행. A-line이나 C-line이 먼저가 아님. Vital sign 유지 – 혈압이 높다고 급하게 낮추.. 2020. 11. 27. 이전 1 다음 728x90
