Pengantar

Anatomi Fisiologi

Assessment

Management
 Trauma mayor yang umum terjadi
4 juta orang mengalami trauma kepala
per tahunnya
Trauma kepala berat paling banyak menyebabkan
kematian.

Populasi yang beresiko

Laki-laki usia 15-24
Infants
Anak-anak
Lansia
 Program Pencegahan Kecelakaan
Safety riding (Motorcycle& Bicycle Safety)
Helmet & Head Injury Awareness Programs
Other Sports
Football
Rollerblading
 TIME IS CRITICAL
Perdarahan Intracranial
Progressing Edema
TIK meningkat
Hipoksia Cerebral
Kerusakan Permanen

Tingkat keparahan sulit dikenali

Subtle signs (gejala tidak terlihat)
 Anatomi & Fisiologi Kepala
Kulit kepala (scalp)
Tulang Cranium
Meninges
Cairan Cerebrospinal
Otak
Sirkulasi sistem saraf pusat (SSP)
Blood-Brain Barrier
Cerebral Perfusion Pressure (CPP)
Saraf kranial
Ascending Reticular Activating System
 Kulit kepala
Strong Flexible mass of
Kulit
Fascia
Muscular Tissue
Highly Vascular
Hair provides Insulation
Structures Beneath
Galea Aponeurotica
Antara kulit kepala dan tulang cranium
Fibrous connective sheath
Jaringan Subaponeurotica (Areolar)
Permits venous blood flow from the dural sinuses to the venous vessels of
scalp
Emissary Veins: Potential route for Infection
 Recalling Structures of the Scalp
S - skin
C - connective tissue
A - aponeurotica
L - layer of areolar tissue
P - periosteum of skull
 Tulang tengkorak terdiri dari:
Facial bones
Tulang kranium
Pelindung otak
Strong, light, rigid, spherical bone
Tulang
Frontal
Parietal
Occipital
Temporal
Ethmoid
Sphenoid
 Meninges
Protective mechanism for the CNS
Dura Mater
Layers
Outer: Craniums inner periosteum
Inner: Dural Layer
Between: Dural Sinuses:
Venous drains for brain
Provides continuous connective tissue
Forms partial structural divisions
Falx cerebri
Tentorium cerebelli
Large arteries above
Provide blood flow to the surface of the brain
 Meninges
Pia Mater
Closest to brain and spinal cord
Delicate tissue
Covers all areas of brain and spinal cord
Very Vascular
Supply superficial areas of brain
Arachnoid Membrane
Spider-like
Covers inner dura
Suspends brain in cranial cavity
Collagen & Elastin fibers
Subarachnoid Space beneath
CSF
Cushions brain
 Cerebrospinal Fluid
Clear, colorless fluid
Comprised of
Water
Protein
Salts
Cushions CNS
Made in largest two ventricles of brain
Medium for nutrients and waste products to diffuse
into and out of brain
 Brain
Occupies 80% of cranium
Comprised of 3 Major Structures
Cerebrum
Cerebellum
Brainstem
High metabolic rate
Receives 15% of cardiac output
Consumes 20% of bodys oxygen
Requires constant circulation
IF Blood supply stops
Unconscious within 10 seconds
Death in 4-6 minutes
 Cerebrum
Function
Center of conscious thought, personality, speech, and motor control
Visual, auditory, and tactile perception
Lobes
Frontal
Personality
Parietal
Motor & Sensory Activity
Memory & Emotion
Occipital
Sight
Temporal
Long-term memory (continued)
Hearing, Speech, Taste & Smell
 Cerebrum
Falx Cerebri
Divides cerebrum into right and left hemispheres
Central Sulcus
Fissure splits cerebrum into right and left hemispheres
Each hemisphere controls the opposite side of the body
Tentorium
Fibrous sheet within occipital region
Brainstem perforates thru incisura tentorri cerebelli
Occulomotor Nerve (CN-III) travels along
Controls pupil size
Compression results in pupillary disturbances
 Cerebrum
Hemisphere Functions
Left: DOMINANT
Mathematical computations: Occipital
Writing: Parietal
Language interpretation: Occipital
Speech: Frontal
Right: NON-DOMINANT
Non-verbal imagery
 Cerebellum
Located under tentorium
Function
Fine tunes motor control
Allows smooth movement
Balance
Maintenance of muscle tone
 Brainstem
Central processing center
Communication junction among
Cerebrum
Spinal cord
Cranial nerves
Cerebellum
Structures
Midbrain
Pons
Medulla Oblongata
 Midbrain
Upper portion of brainstem
Structures
Hypothalamus
Endocrine function, vomiting reflex, hunger, thirst
Kidney function, body temperature, emotion
Thalamus
Switching center between pons & cerebrum
Critical Element in Ascending Reticular Activating System (A-RAS)
ESTABLISHES CONSCIOUSNESS
Major pathways for optic & olfactory nerves
Associated Structures
 Pons
Communication interchange between cerebellum, cerebrum,
midbrain, and spinal cord
Bulb shaped structure above medulla
Sleeping phase of the RAS
 Medulla Oblongata
Bulge in the top of the spinal cord
Centers
Respiratory Center
Controls depth, rate and rhythm
Cardiac Center
Regulates rate and strength of cardiac contractions
Vasomotor Center
Distribution of blood
Maintains blood pressure
 CNS Circulation
Arterial
Four Major Arteries
2 Internal Carotid Arteries
From the common carotid
2 Vertebral Arteries
Circle of Willis
Internal Carotids and Vertebral Arteries
Encircle the base of the brain
Venous
Venous drainage occurs through bridging veins
Bridge Dural Sinuses
Drain into internal jugular veins
 Blood-Brain Barrier
Less permeable than elsewhere in body
DO NOT allow flow of interstitial proteins
Reduced lymphatic flow
Very protected environment
Blood acts as irritant resulting in cerebral edema
 Cerebral Perfusion Pressure
Pressure within cranium (ICP) resists blood flow and good
perfusion to the CNS
Pressure usually less than 10 mmHg
Mean Arterial Pressure (MAP)
Must be at least 50 mmHg to ensure adequate perfusion
MAP = DBP + 1/3 Pulse Pressure
Cerebral Perfusion Pressure (CPP)
Pressure moving blood through the cranium
CPP = MAP - ICP
 Calculating MAP

BP 120/90
DBP 90
Pulse Pressure 120 - 90 30
MAP 90 13 30 100
Calculating CPP

MAP 90 & ICP 10

CPP MAP - ICP
CPP 100 - 10 90
 Cerebral Perfusion Pressure
Autoregulation
Changes in ICP result in compensation
Increased ICP = Increased BP
This causes ICP to rise higher and BP to rise
Brain injury and death become imminent
Expanding mass inside cranial vault
Displaces CSF
If pressure increases, brain tissue is displaced
 Cranial Nerves
12 pair with distinct pathways
Senses, facial innervation, & body function control

Ascending Reticular Activation System

Tract of neurons in upper brainstem, pons, and midbrain
Responsible for sleep-wake cycle
Monitors input stimulation
Regulates body functions
Respiration
Heart Rate
Peripheral Vascular Resistance
Injury may result in prolonged waking state
CN Name F Innervasi
I Olfactory S Smell
II Optic S Sight
III Oculomotor M Pupil Const, Rectus & Obliques
IV Trochlear M Superior Obliques
S Opthalmic (FH), Maxillary (cheek) Mandible (chin)
V Trigeminal
M Chewing muscles
VI Abducens M Lateral rectus muscle
S Tongue
VII Facial
M Face Muscles
VIII Acoustic S Hearing balance

Glossopharyn- S Posterior pharynx, taste to anterior tongue

IX
geal M Face Muscles
S Taste to posterior tongue
X Vagus
M Posterior palate and pharynx
XI Accessory M Trapezius & Sternocleido. Muscles
XII Hypoglossal M Tongue
 Anatomy & Physiology of the Face
Structure
Ear
Eye
 Structure
Facial Bones
Zygoma
Prominent bone of the cheek
Protects eyes
Attachment for muscles controlling eye & jaw movement
Maxilla
Upper jaw
Supports the nasal bone
Provides lower border of orbit
Mandible
Jaw bone
Nasal Bones
 Structure
Covered with skin
Flexible and thin
Highly vascular
Minimal layer of subcutaneous tissue

Circulation
External carotid artery
Supplies facial area
Branches
Facial, Temporal & Maxillary Arteries
 Nerves
Trigeminal (CN-V)
Facial Sensation
Some eye motor control
Enables chewing process
Facial (CN-VII)
Motor control for facial muscles
Sensation of taste
 Nasal Cavity
Upper Border
Bones
Junction of Ethmoid, Nasal, & Maxillary Bones
Bony Septum
Right & Left Chamber
Turbinates
Vascular mucosa support
Warm, Humidify, and Filter incoming air
Lower Border
Bony Hard Palate
Soft Palate
Moves upward during swallowing
Nasal Cartilage
Forms Nares
 Oral Cavity
Formed Structures
Maxillary bone
Palate
Upper teeth meeting the mandible and lower teeth
Floor
Tongue
Connects to hyoid bone
Free-floating U-shaped bone inferior & posterior of the
mandible
Mandible
Articulates with the TMJ joint
 Special Structures
Salivary Glands
First stage in digestion
Location
Anterior and inferior to the ear
Under tongue
Inside the inferior mandible
Tonsils
Posterior wall of the pharynx

(continued)
 Sinuses
Hollow spaces in cranium and facial bones
Function
Lighten head
Protect eyes and nasal cavity
Produce resonant tones of voice
Strengthen area against trauma
 Cranial Nerves
CN-XII (Hypoglossal)
Swallowing & tongue movement

CN-IX (Glossopharyngeal)
Saliva production & taste

CN-V (Trigeminal)
Sensations from facial region & aids in chewing

CN-VII (Facial)
Muscles of facial expression & taste
 Pharynx
Posterior & Inferior to the oral cavity
Aids in swallowing
Bolus of food propelled back & down by tongue
Epiglottis moves downward
Larynx moves up
Combined effect seals airway
Peristaltic wave moves food down esophagus
 Ear
Function
Hearing
Positional sense
Structures
Pinna
Outer visible portion
Formed of Cartilage & has Poor blood supply
External Auditory Canal
Glands that secrete cerumen (wax)
Middle & Inner Ear
Structures for hearing and positional sense
 Ear
Structures for Hearing
Tympanic membrane
Ossicle bones
Cochlea
Auditory Nerve
Structures for Proprioception
Semicircular canals
Sense position & motion
Present when eyes are closed
Vertigo
Continuous movement sensation
 Eye
Structures
Sclera
Cornea
Conjunctiva
Anterior Chamber
Aqueous humor
Iris
Pupil
Lens
Posterior Chamber
Vitreous humor
Retina
Lacrimal Fluid
Bathes, protects, and nourishes cornea
 Eye
Innervation
CN-III (Oculomotor)
Pupil dilation
Conjugate movement
Movement of eyes together
Normal range of motion
CN-IV (Trochlear)
Downward & inward movement
CN-VI (Abducens)
Abduction (outward) gaze
 Vasculature of the Neck
Carotid Arteries
Arise from
RIGHT: Brachiocephalic Artery
LEFT: Aorta Artery
Split
Internal & External Carotid Arteries
Upper border of the Larynx
Carotid Bodies & Sinuses located
Bodies: Monitor CO2 and O2 levels
Sinuses: Monitor Blood Pressure
(continued)
 Jugular Veins
External
Superficial, lateral to the trachea
Internal
Sheath with the carotid artery and vagus nerve
 Airway Structures
Larynx
Epiglottis
Thyroid & Cricoid Cartilage
Trachea
Posterior border is anterior border of esophagus
 Other Structures
Cervical Spine
Musculoskeletal Function
External Skeletal support of the head and neck
Attachment point for spinal column ligaments
Attachment point for tendons to move head and
shoulders
Nervous Function
Spinal Cord contained within
Peripheral Nerve
Exit between vertebrae
 Other Structures
Esophagus
Cranial Nerves
CN-IX (Glossopharyngeal)
Carotid Bodies & Carotid Sinuses
CN-X
Speech, swallowing, cardiac, respiratory & visceral function
Thoracic Duct
Delivers lymph to the venous system

(continued)
 Glands
Thyroid
Rate of cellular metabolism
Systemic levels of calcium
Brachial Plexus
Network of nerves in lower neck and should that control arm and
hand function
 Mechanism of Injury
Blunt Injury
Motor vehicle collisions
Assaults
Falls
Penetrating Injury
Gunshot wounds
Stabbing
Explosions
Clothesline
 Contusions
Lacerations
Avulsions
Significant Hemorrhage

ALWAYS Reconsider MOI for severe underlying problems

 Trauma must be extreme to fracture
Linear
Depressed
Open
Impaled Object

Basal Skull
Unprotected
Spaces weaken
structure
Relatively
easier to fracture
 Basal Skull Fracture Signs
Battles Signs
Retroauricular Ecchymosis
Associated with fracture of
auditory canal and lower
areas of skull
Raccoon Eyes
Bilateral Periorbital
Ecchymosis
Associated with orbital
fractures
 Basilar Skull Fracture
May tear dura
Permit CSF to drain through
an external passageway
May mediate rise of ICP
Evaluate for Target or
Halo sign
 As defined by the National Head Injury Foundation
a traumatic insult to the brain capable of producing
physical, intellectual, emotional, social and vocational
changes.
Classification
Direct
Primary injury caused by forces of trauma
Indirect
Secondary injury caused by factors resulting from the primary
injury
 Coup
Injury at site of impact

Contrecoup
Injury on opposite side
from impact
 Focal
Occur at a specific location in brain
Differentials
Cerebral Contusion
Intracranial Hemorrhage
Epidural hematoma
Subdural hematoma
Intracerebral Hemorrhage

Diffuse
Concussion
Moderate Diffuse Axonal Injury
Severe Diffuse Axonal Injury
 Cerebral Contusion
Blunt trauma to local brain tissue
Capillary bleeding into brain tissue
Common with blunt head trauma
Confusion
Neurologic deficit
Personality changes
Vision changes
Speech changes
Results from
Coup-contrecoup injury
 Epidural Hematoma
Bleeding between dura mater
and skull
Involves arteries
Middle meningeal artery most
common
Rapid bleeding & reduction of
oxygen to tissues
Herniates brain toward
foramen magnum
 Subdural Hematoma
Bleeding within meninges
Beneath dura mater & within
subarachnoid space
Above pia mater
Slow bleeding
Superior sagital sinus
Signs progress over several
days
Slow deterioration of mentation
 Intracerebral Hemorrhage
Rupture blood vessel within the brain
Presentation similar to stroke symptoms
Signs and symptoms worsen over time
 Due to stretching forces placed on axons
Pathology distributed throughout brain
Types
Concussion
Moderate Diffuse Axonal Injury
Severe Diffuse Axonal Injury
 Mild to moderate form of Diffuse Axonal
Injury (DAI)
Nerve dysfunction without anatomic damage

Transient episode of
Confusion, Disorientation, Event amnesia

Suspect if patient has a momentary loss of

consciousness
Management
Frequent reassessment of mentation
ABCs
 Classic Concussion
Same mechanism as concussion
Additional: Minute bruising of brain tissue

Unconsciousness
If cerebral cortex and RAS involved

May exist with a basilar skull fracture

Signs & Symptoms
Unconsciousness or Persistent confusion
Loss of concentration, disorientation
Retrograde & Antegrade amnesia
Visual and sensory disturbances
Mood or Personality changes
 Brainstem Injury
Significant mechanical disruption of axons
Cerebral hemispheres and brainstem

High mortality rate

Signs & Symptoms
Prolonged unconsciousness
Cushings reflex
Decorticate or Decerebrate posturing
 Review
Cranial volume fixed
80% = Cerebrum, cerebellum & brainstem
12% = Blood vessels & blood
8% = CSF
Increase in size of one component diminishes size
of another
Inability to adjust = increased ICP
 Compensating for Pressure
Compress venous blood vessels
Reduction in free CSF
Pushed into spinal cord ICP BP
Decompensating for Pressure
Increase in ICP
Rise in systemic BP to perfuse brain
Further increase of ICP
Dangerous cycle
 Role of Carbon Dioxide
Increase of CO2 in CSF
Cerebral Vasodilation
Encourage blood flow
Reduce hypercarbia
Reduce hypoxia
Contributes to ICP
Causes classic
Hyperventilation & Hypertension
Reduced levels of CO2 in CSF
Cerebral vasoconstriction
Results in cerebral anoxia
 Vasculature Constriction
Cerebral Edema
Systolic Blood Pressure
Low BP = Poor Cerebral Perfusion
High BP = Increased ICP

Carbon Dioxide
Reduced respiratory efficiency
 Increased pressure
Compresses brain tissue
Against & around
Falx Cerebri
Tentorium Cerebelli

Herniates brainstem
Compromises blood supply
Signs & Symptoms
Upper Brainstem
Vomiting
Altered mental status
Pupillary dilation
Medulla Oblongata
Respiratory
Cardiovascular
Blood Pressure disturbances
 Altered Mental Status Vomiting
Altered orientation Tanpa mual
Alteration in personality Proyektil
Amnesia
Retrograde
Perubahan suhu tubuh
Antegrade
Perubahan pupil
Cushings Reflex
Postur decorticate
Increased BP
Bradycardia
Erratic respirations
 Pathophysiology of Changes
Frontal Lobe Injury
Alterations in personality
Occipital Lobe Injury
Visual disturbances
Cortical Disruption
Reduce mental status or Amnesia
Retrograde
Unable to recall events before injury
Antegrade
Unable to recall events after trauma
Repetitive Questioning
Focal Deficits
Hemiplegia, Weakness or Seizures
 Upper Brainstem Compression
Increasing blood pressure
Reflex bradycardia
Vagus nerve stimulation
Cheyne-Stokes respirations
Pupils become small and reactive
Decorticate posturing
Neural pathway disruption
 Middle Brainstem Compression
Widening pulse pressure
Increasing bradycardia
CNS Hyperventilation
Deep and Rapid
Bilateral pupil sluggishness or inactivity
Decerebrate posturing
 Lower Brainstem Injury
Pupils dilated and unreactive
Ataxic respirations
Erratic with no pattern
Irregular and erratic pulse rate
ECG Changes
Hypotension
Loss of response to painful stimuli
 Different pathology than older patients
Skull can distort due to anterior and posterior fontanelles
Bulging
Slows progression of increasing ICP
Intracranial hemorrhage contributes to hypovolemia
Decreased blood volume in peds

General Management
Avoid hyperextension of head
Tongue pushes soft pallet closed
Ventilate through mouth and nose
 Physiological Issues
Indicate pressure on
CN-II, CN-III, CN-IV, & CN-VI
CN-III (Oculomotor Nerve)
Pressure on nerve causes eyes to be sluggish, then dilated, and
finally fixed
Reduced peripheral blood flow

Pupil Size & Reactivity

Reduced Pupillary Responsiveness
Depressant drugs or Cerebral Hypoxia
Fixed & Dilated
Extreme Hypoxia
 Facial Soft Tissue Injury
Highly vascular tissue
Contribute to hypovolemia
Superficial injuries rarely life threatening and
rarely involve the airway
Deep Injuries can result in blood being swallowed
and endanger the airway
Soft tissue swelling reduces airflow
Consider likelihood of basilar skull fracture or
spinal injury
 Facial Dislocations & Fractures
Common Fractures
Mandibular
Deformity along jaw & loss of teeth
Possible airway compromise if patient placed supine
Evaluate for multiple fracture sites
Maxillary & Nasal
Le Fort I, II and III Criteria
Orbit
Involve Zygoma, Maxilla, and/or interior shelf
Reduction of eye movement
Possible Diplopia
Limitation of jaw movement
 Nasal Injury
Rarely life threatening
Swelling & Hemorrhage interfere with breathing
Epistaxis
Most common problem
AVOID NASOTRACHEAL INTUBATION
Passage of ET tube into the cerebral cavity
 Ear Injury
External Ear
Pinna is frequently injured due to trauma
Poor blood supply
Poor healing
Internal Ear
Well protected from trauma
My be injured due to rapid pressure changes
Diving, Blast, or Explosions
Temporary or permanent hearing loss
Tinnitus may occur
 Eye Injury
Penetrating trauma
can result in long term damage
Suspect small foreign body if patient complains of sudden eye
pain and sensation of something on the eye
DO NOT REMOVE ANY FOREIGN OBJECT
Corneal Abrasions & Lacerations
Common & usually superficial
Hyphema
Blunt trauma to the anterior chamber of the eye
Blood in front of iris or pupil
Sub-conjunctival Hemorrhage
Less serious condition
May occur after strong sneeze, severe vomiting or direct trauma
 Eye Injury
Acute Retinal Artery Occlusion
Non-traumatic origin
Painless loss of vision in one eye
Occlusion of retinal artery
Retinal Detachment
Traumatic origin
Complaint of dark curtain/obstruction in the field of view
Possibly painful depending on type of trauma
Soft Tissue Lacerations
 Blood Vessel Trauma
Blunt trauma
Serious hematoma
Laceration
Serious exsanguination
Entraining of air embolism
Cover with occlusive dressing

Airway Trauma
Tracheal rupture or dissection from larynx
Airway swelling & compromise
 Cervical Spine Trauma
Vertebral fracture
Paresthesia, anaesthesia, paresis or paralysis beneath the level of
the injury
Neurogenic shock may occur

Other Neck Trauma

Subcutaneous emphysema
Tension pneumothorax
Traumatic asphyxia
Penetrating Trauma
Esophagus or Trachea
Vagus nerve disruption
Tachycardia & GI disturbances
Thyroid & Parathyroid glands
High vascular
 Scene Size-up
Initial Assessment
Airway, Breathing, Circulation

Rapid Trauma Assessment

Head, Face, Neck
Glasgow Coma Scale Score
Vital Signs

Focused History & Physical Exam

Detailed Assessment
Ongoing Assessment
 Airway Breathing
Suctioning Oksigen: 15 l/mnt ` NRB
Patient Positioning Ventilasi: 12-20 x/mnt,
OPA & NPA Use hiperoksigen
Endotracheal Intubation
Circulation
Orotracheal
Kontrol perdarahan
Digital
Pertahankan TD dengan
Nasotracheal
resusitasi cairan,
Retrograde pertimbangkan
Direct penggunaan PASG
RSI
Cricothyrotomy
 Hypoxia
Prevent/Reduce
Hyperoxygenation with BVM

Hypovolemia
Reduces cerebral perfusion & hypoxia
Consider early management with 2 large bore IVs and
isotonic fluids
Prevents slower compensatory mechanism
Maintain SBP 90-100 mmHg

Consider PASG
 Primary 1st line drug
Administer high flow
Hyperventilation is contraindicated
Reduces circulating CO2 levels

NRB: 15 LPM
BVM: 12-20 times per minute

Keep SaO2 > 95%

 Mannitol (osmotrol)
MOA
Large glucose molecule
Does not leave blood stream
Osmotic Diuretic
Effective in drawing fluid from brain
Contraindication
Hypovolemia & Hypotension
CHF
Dose
1gm/kg
CAUTION
Forms crystals at low temperatures
Reconstitute with rewarming & gentle agitation
USE IN-LINE filter & PREFLUSH line
 Furosemide (Lasix)
MOA
Loop Diuretic
+
Inhibits reabsorption of Na in Kidneys
Increased secretion of water and electrolytes
+ ++
Na , Cl , Mg , Ca++.
Venous dilation & Reduces cardiac preload
May be given in combination with Mannitol
Contraindication
Pregnancy: fetal abnormalities
Dose
Slow IVP or IM over 1-2 minutes
0.5-1 mg/kg: Commonly 40 or 80 mg
 Succinylcholine (Anectine)
MOA
Depolarizing Medication
Causes Fasciculations
Onset & Duration
Onset: 30-60 seconds
Duration: 2-3 minutes
Precaution
Paralyzes ALL muscles including those of respiration
Increases intraoccular eye pressure
Contraindication
Penetrating eye injury & Digitalis
Dose
1-1.5 mg/kg IV
Consider administration of 0.5 mg of Atropine to reduce
fasciculations
Pancuronium
Vecuronium
(Pavulon)
MOA (Norcuron)
Non-depolarizing agent
MOA
Does not affect LOC
Non-depolarizing
Onset & Duration
agent
Onset: 3-5 min
Does not affect LOC
Duration: 30-60 min
Dose Onset & Duration
Must premed with sedative Onset: < 1 min
0.04-0.1 mg/kg Duration: 25-40 min
Dose
Consider premed with
sedative
0.08-0.1 mg/kg
 Diazepam (Valium)
MOA
Midazolam
Benzodiazepine
Anti-anxiety
(Versed)
Muscle relaxant MOA
Onset & Duration Benzodiazepine
Onset: 1-15 min
3-4x potent than
Duration: 15-60 min
valium
Dose
5-10 mg Dose
SLOW IVP
1 mg/min
1-2.5 mg titrated
 Morphine
MOA
Opium alkaloid
Analgesic
Sedation
Anti-anxiety
Reduces vascular volume & cardiac preload
Increases venous capacitance
Side Effects
Respiratory depression
Hypovolemia
Dose
5-10 mg IVP
Consider using promethezine with to reduce nausea
Naloxone (Narcan) is antagonist
 MOA
Anticholinergic
Parasympathetic
Reduces parasympatholyic stimulation
Reduce oral and airway secretions
Reduce fasciculations
Pupillary dilation

Dose
0.5-1 mg rapid IVP
 Consider if patient is hypoglycemic
Only if VERIFIED by GLUCOMETER

Dose
25 gm IVP
Consider Thiamine if known alcoholic
100 mg Thiamine
 Vitamin B1
Essential for the processing of glucose through Krebs cycle
Chronic alcoholics can have B1 depletion
Dose
100 mg IV or IM
 Medications
Xylocaine or Benzocaine
Anesthetize oral and pharyngeal mucosa
Reduces gag reflex
Reduces likelihood of ICP associated with vomiting
Inhibits nerve sensation
Onset & Duration
Onset: 15 seconds
Duration: 15 minutes
PRECAUTION
Patient has reduced ability to remove oral fluids
ASPIRATION can occur
 Limit external stimulation
Can increase ICP
Can induce seizures

Cautious about Air Transport

Seizures
 Have friend or family provide constant reassurance
Provided constant reorientation to environment if required
Keeps patient calm
Reduces anxiety
 Scalp Avulsion
Cover the open wound with bulky dressing
Pad under the fold of the scalp
Irrigate with NS to remove gross contamination

Pinna Injury
Place in close anatomic position as possible
Dress and cover with sterile dressing
 Eye Injury
General Injury
Cover injured and uninjured eye
Prevents sympathetic motion
Consider sterile dressing soaked in NS
Corneal Abrasion
Invert eyelid and examine eye for foreign body
Remove with NS moistened gauze or Morgans Lens
Avulsed or Impaled Eye
Cover and Protect from injury
General Care
Calm & reassure patient
 Dislodged Teeth
Rinse in NS
Wrap in NS soaked gauze

Impaled Objects
Secure with bulky dressing
Stabilize object to prevent movement
Indirect pressure around wound