1, scalp injury: scalp abrasion, scalp laceration, scalp hematoma (subcutaneous hematoma, subcapsular tendon hematoma, subperiosteal hematoma, scalp contusion, scalp avulsion injury.
2. Skull injury: linear fracture (linear fracture of skull cap, linear fracture of skull base), comminuted fracture, depressed fracture (greater than 1 cm needs to be treated), penetrating fracture. Note whether it is an open skullcap/skull base fracture.
3, intracranial injury: concussion, meaning disorder less than half an hour, retrograde amnesia/proximal amnesia; physical examination, CSF, head CT are no abnormal findings, there are neurological symptoms such as headache nausea and irritability without positive neurological signs, observe symptomatic treatment.
4, cerebral contusion: meaning impairment for a long time, physical examination with signs, CSF hemorrhagic, head CT shows dotted sheet hemorrhagic edema area, conservative and surgery are to lower the cranial pressure.
5, primary brainstem injury: progressive aggravation of meaning disorder, pupil size variable and light reflex disappeared, physical examination cone bundle signs, cranial nerve and respiratory circulation center involvement performance, observation symptomatic treatment.
6, diffuse axonal injury DAI (white matter injury): clinical manifestations are heavy and persistent, CSF pressure is normal, head CT can also be normal or with multiple small hemorrhagic foci; observe symptomatic treatment.
7, intracranial hematoma: intracranial extracerebral hematoma, i.e., epidural hematoma (at the trans-cranial suture due to the tight combination of dura and cranial suture, the hematoma is often centered on the cranial suture and forms a biconvex lens-shaped hematoma on each side of the cranial suture, with an overall “3” shape and anti “3” shape) and Subdural hematomas (acute within 3 days, subacute within 4 days-3 weeks, chronic over 3 weeks), traumatic SAH, cerebral hemorrhage, intraventricular hemorrhage, and multiple intracranial hematomas. Meaning disorders are variable i.e. they can be wakefulness to coma or coma-intermediate wakefulness-coma (this is mostly seen in epidural hematomas with milder occupying effects). The gold standard for diagnosis is CT, but for skull base and cranial vault hematomas, it is often difficult to identify them on cross-sectional scans due to artifacts and partial volume effects, and CT coronal scan or MRI coronal scan should be performed.
8, cerebral edema, brain swelling, brain swelling: cerebral edema generally refers to intracellular edema, brain swelling generally refers to extracellular edema with vasodilatation, and brain swelling is defined according to morphology. Brain edema CT shows white matter density lower than brain parenchyma, brain swelling CT shows white matter density equal to or higher than brain parenchyma (brain swelling due to cerebral vasodilatation and congestion).
9, subdural fluid/subdural hydrocele: It is a rupture of the arachnoid membrane CSF flows between the dura and the arachnoid membrane, mostly forming a one-way live flap, requiring bone flap craniotomy to remove the cyst wall and open up with the brain pool. It is often necessary to identify chronic subdural hematoma.
10, compound craniocerebral trauma: refers to the injured person has both craniocerebral trauma and other parts of the body injury. The “golden hour” after the injury has been recognized by the majority of clinical practitioners.
ABCDE process.
Airway: to determine whether there is patency and prevent airway obstruction.
Breathing: to understand whether the breathing is normal and to prevent the presence of tension pneumothorax and shackle chest.
Circulation: check blood pressure and pulse to prevent shock or bleeding.
Disability: observation of conscious pupillary light reflex, GCS score, presence of hemiparesis, pathology film.
Exposure: quickly and adequately reveal all parts of the patient to estimate whether there are important trauma basis.
VIPCO process: Ventilation: ensure unobstructed respiratory pathway and ventilation and oxygen administration, tracheotomy and assisted breathing or tracheal intubation if necessary, and closed chest drainage in time for pneumothorax to maintain normal respiratory function.
Infusion: immediately establish effective intravenous access, rapid infusion of fluids, blood transfusion and volume expansion.
Pulsation: monitoring of cardiac pulsation and heart pump function to prevent pericardial blockage.
Controlbleeding: control bleeding.
Operation: transfer to the ward and operating room is not allowed due to critical condition, and resuscitation is performed in the emergency room when necessary.
11.Post-traumatic brain injury sequelae: traumatic hydrocephalus, traumatic epilepsy, ventricular penetration malformation, secondary/traumatic arachnoid cyst, cerebral atrophy, cerebral softening, skull defect, post-traumatic brain injury syndrome, etc.
12, post-traumatic brain syndrome: manifestation of headache and dizziness and autonomic nervous system dysfunction is the main three aspects, NS examination without positive findings, the diagnosis of this disease should be cautious, need to exclude the possibility of organic lesions of brain injury.