-Penetrating - Surgery/repair
-Linear fractures- Open (close wound). Closed (Leave alone)
If Pt Unconscious - Head CT
-Base injury - Racoon eyes, epistaxis, ecchymosis. --Expectant mgmt, CT spine for integrity.
-Neurological trauma- Caused by : Blow, Hematoma (surgery), or ICP increase (medication to prevent)
-Epidural Hematoma - MMA damaged in trauma to side of head. Present with trauma-unconscious-lucid interval-coma-dilated pupil on side of hematoma-contralateral hemipariesis. Treat with craniotomy
-Subdural Hematoma - More severe, crescent shaped, craniotomy only helps if midline structures are deviated, montior ICP. Give mannitol or furosemide, hyperventilate (35 pco2)- Chronic pts are old, or alchoholics, shrunken brain tears venous sinuses. Mental function deteriorates, CT scan dx, tx with surgery.
-Diffuse axonal injury- Blur of gray and white matter interface, and multiple punctuate hemorrhages, prevent further damage by dec ICP.