Shock (pathophysiology,

assessment and principles of

treatment of shock)

Kenan Karavdi, Assistant

Professor

Shock (pathophysiology, assessment

and principles of treatment of shock)

Shock is a syndrome caused by a

variety of primary events, and tissue
hypoxia,
which
causes
severe
damage to cells (tissue) and
parenchymal
organs
with
fatal
outcome if the weather does not
intervene.

Shock (pathophysiology, assessment

and principles of treatment of shock)

Cardiogenic (most often in patients

with acute myocardial infarction)
Hypovolemic (external and internal
bleeding, loss of body fluids)
Obstructive (pulmonary embolism,
aortic dissection)
Distribution (usually septic)

Shock
Circulatory system failure which
happens when insufficient amounts
of oxygenated blood is provided for
every body part. This can be as the
result of:
Loss of blood due to uncontrolled
bleeding or other circulatory system
problem.
Loss of fluid due to dehydration or
excessive sweating.
Trauma (injury)
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Shock (pathophysiology, assessment

and principles of treatment of shock)
On the development of the syndrome of shock, as part of the
underlying disease (etiological moment), and indicate the following
parameters:
hypotension (systolic blood pressure less than 90 mmHg or 12 kPa)
decreased urine output (less than 20 ml / h, according to some
authors, less than 0.5 mL / kg BW / h)
progressive increase in the concentration of lactate in
arterial blood while reducing the concentration of bicarbonate
pCO2, with signs of tissue hypoperfusion
disturbance of consciousness (excitation, but the depression of
consciousness),
heart rhythm disorder
peripheral cyanosis, and with it are usually present and signs of
compensatory mechanisms of the organism: tachycardia, tachypnea
and sweating

Shock Cont.

What to Do
After first treating life-threatening
injuries such as breathing or
bleeding, the following procedures
shall be performed:
Lay the victim on his or her back
Raise the victims legs 8 12 to
allow the blood to drain from the
legs back to the heart.
Prevent body heat loss by putting
blankets and coats under and over the
victim
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Shock Cont.
What to Look For
Altered mental status
Anxiety and restlessness

Pale, cold, and clammy skin, lips, and nail

beds
Nausea and vomiting
Rapid breathing and pulse
Unresponsiveness when shock is severe

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Principles of treatment of shock

+ Emergency medical help (EMH)
1. Position of patient
Anaphylactic position: on the back, face up, feet slightly
elevated (soil under the feet of 20 - 30cm), patient drowned
NO - Trendelenburg position (leaning head down and raised
the lower part) because abdominal organs put pressure on the
diaphragm and make it difficult to breathe.
Semi-sitting position: where permitted by the state of
consciousness of patients with certain injuries, for example,
head, chest or diseases like pulmonary edema, cardiogenic
shock. This position prevents the onset of atelectasis
(insufficient fulfillment lungs with incomplete expansion of
parenchyma) it allows the abdominal organs and diaphragm
lowered and increases lung volume and makes it easier to
breathe and reduces the risk of aspiration of gastric contents.

Oxygenation

Ensuring adequate oxygenation in order to achieve a pO2 of

at least 8 kPa (60 mmHg), which is sufficient for 90%
saturation
of
hemoglobin.
Oxygenation
can
be
accomplished in several ways:
a) By means of a nasal cannula or mask over. It is
necessary to have a bottle of oxygen. Fully acceptable flow
is 6-8 l / min. the concentration of oxygen in the inspired air
around 35-40%, while the flow of 10 l / min. give a
concentration of about 50% . This can be done in the field
and during transport the patient to the hospital.
One should be very careful because giving very high
concentrations of oxygen in the inhaled air (100%
provision) may adversely affect in terms of developing
ARDS - a.
b) Through a respirator, for which patients should be
intubated (time or nasotracheal).

Maintenance of
circulating
volume
The loss
of circulating volume (either
in internal or external

bleeding or loss of other bodily fluids) is the main reason

hypovolemic shock. But the relative hypovolemia is a side
effect of all types of shock (except cardiogenic, when with
hypotension and hypoperfusion and we have high
pulmonary capillary pressure and pulmonary edema).
Therefore, careful replacement of circulating volume is very
important in the treatment of shock syndrome. The volume
expansion are available crystalloid and colloid solutions and
blood products. There was no significant difference in
survival using one or the other solution.
In the pre-hospital care is necessary to promptly begin
with replacement fluids, keeping in mind the need for
much greater amount of crystalloid solution (0.9% NaCl)
than colloidal. If it is a big loss of circulating volume,
working as fast restoration of circulating volume and
stabilization during the transportation, starch solutions are
preferred.

Maintaining diuresis and

electrolyte balance
Oliguria is one of the clinical signs of shock syndrome, and is primarily
a consequence of decreased renal circulation. When
a suitable
replacement of circulating volume was performed, and pressure values
(with drugs) maintained within acceptable limits, often renal function
recovers, although sometimes need stimulation and diuresis. How
syndrome is not just a question of circulating volume and blood
pressure, often after improvement of these parameters remains
oliguria, ie. develops acute renal kidney being treated by hemodialysis.
Any disorder of renal function carries and electrolytic disorders,
especially dangerous hyperkalemia, and acid-base disturbances or
accumulation acid products of metabolism in the body. Careful
correction of these disorders are very important for the overall outcome
of the treatment of this condition. Therefore, patients in shock must
introduce a permanent urinary catheter and monitor hourly urine output
(diuresis initially <0.5 ml / kg BW / hour request correction or
modification of therapy), and frequently monitor electrolyte and acidbase status.

Analgesia and sedation

Pain relieving and calming the
patient is of great importance
because the pain and accompanying
discomfort and agitation increasing
the consumption of oxygen. However
one should be careful with the use of
narcotics and sedatives but that is
not deepen the possible impairment
of consciousness

Treatment and prevention of

cardiac arrhythmias
In patients who do not have primary cardiogenic shock
often develop different rhythm disorders as result of
hypoxia, acidosis, electrolyte imbalance, and some
substances that are release in the body and have a
direct effect on the myocardium. All serious
supraventricular (tachy and bradyarrhythmia), and
ventricular, should be removed as soon as an additional
influence on the function of the heart as pumps.
The best prevention are adequate oxygenation,
perfusion good electrolyte and acid-base because the
status of all drugs used in the treatment of arrhythmias
have higher or lower negative inotropic

WOUNDS
Kenan Karavdi, Assistant
Professor

WOUNDS
Traumatic wounds are defined as
termination of anatomical and functional
continuity of tissue or organs, which can
be caused by various factors:
- mechanical,
- thermal,
- chemical,
- biological,
- electrical

WOUNDS

open wounds:
cutting,
puncture,
tearing,
bites,
war wounds,
abrasions
closed wounds:
-contusions,
-distortions,
-rupture,

Basic First Aid for Wounds

Open Wounds
A break in the skins surface that results in
external bleeding and may allow bacteria
to enter the body that can cause infection
Abrasion
The top layer of skin is removed
with little or no blood loss
Scrape

Laceration
A cut skin with jagged, irregular edges
and caused by a forceful tearing away
of skin tissue

Incisions
Smooth edges and resemble
a surgical or paper cut
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Basic First Aid for Wounds

Cont.
Open Wounds Cont.
Punctures
Deep, narrow wounds such as
a stab wound
from a nail or a
knife in the skin and underlying
organs

Avulsion
Flap of skin is torn loose and is either
hanging from the body
or completely removed

Amputation
Cutting orFacilities
tearing
off of a body part
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such as a finger,

WOUNDS
I/ Mechanical - most often caused by grains (with
automatic rifles, machines, guns ...) and various
debris detonating device (fragmentation bombs,
explosive fragments, shells, mines ...).
- a/ gunshot (input, output wounds and gunshot
channel),
- b/ puncture (puncture wounds with the
remaining projectile at the end of gunshot
channel)
- c / tangential wounds (forms are grooves with
possible damage to the deeper layers)

WOUNDS

II / Thermal (burns, frostbite)

III / Electrical
IV / Chemical
V / Radioactive
VI / Associated

Wounds - Urgent medical help

Remove clothing and shoes.

Clean the wound environment with
disinfectant (70% alcohol, Rivanol, iodine
tincture, etc.). Do not wash the wound.
In the early to put sterile gauze or first
bend (sterile bandage with one fixed
cushion cover entry wound and other fixed
pad exit wound - with gunshot wounds).
If the wound bleeds set pressure bandage.

Extremity immobilize and hold on

elevated position.
Due to its specificity and characteristics of
major wounds as those inflicted with

Basic First Aid for Wounds Cont.

What to Do:
Wear gloves (if possible) and expose
wound
Control bleeding
Clean wounds
To prevent infection
Wash shallow wound gently with soap and
water
Wash from the center out / Irrigate with
water

Severe wound?
Clean only after bleeding has stopped

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Basic First Aid for Wounds

Cont.
Wounds Care

Remove small objects that do not flush

out by irrigation with sterile tweezers
If bleeding restarts, apply direct
pressure
Use roller bandages (or tape dressing to
the body)
Keep dressings dry and clean
Change the dressing daily, or more often
if it gets wet or dirty
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Basic First Aid for Wounds Cont.

Signs of Wound Infection:
Swelling, and redness around the wound
A sensation of warmth
Throbbing pain
Fever / chills
Swollen lymph nodes
Red streaks
Tetanus (lock jaw), should receive
injection in first 72 hours.

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Dressings and Bandages

The purpose of a dressing is to:

Control bleeding
Prevent infection and contamination
Absorb blood and fluid drainage
Protect the wound from further injury

What to Do:
Always wear gloves (if possible)
Use a dressing large enough to extend
beyond the wounds edges.
Cover the dressing with bandages.
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Dressings and Bandages Cont.

Bandage can be used to:
Hold a dressing in place over an open
wound
Apply direct pressure over a dressing to
control bleeding
Prevent or reduce swelling
Provide support and stability for an
extremity or joint
Bandage should be clean but need not
be sterile.
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Surgical treatment wound

primary wound
closure
delayed primary
wound closure
secondary wound
closure
Friedriech rule

ANA-TE PROTECTION
Passive immunization:
- Human immunoglobulin (containing specific
antibodies against tetanus toxin) 250 IU
1. If a person was not vaccinated against
tetanus
2. If the vaccination was incomplete
3. If the data abouth vaccination were
incomplete
- Human immunoglobulin 500 IU in severe
injuries pollution (double prophylactic dose)

ANA-TE PROTECTION
Active immunization (VACCINATION)
- Vaccine (containing tetanus anatoxin)
and causes the formation of antibodies
against the toxin of Clostridium tetani
regular vaccination
- Doses of 0.5 ml
-Re-dose after 1-3 months
-Re-dose after 1 year
- New vaccination every 5 years

ANA-TE PROTECTION
vaccination of injured
1. If a person wasnt vaccinated against tetanus
2. If the vaccination is incomplete
3. If the data of vaccination incomplete
Give together immunoglobulin 250 IU and Ana-Te
vaccine 0.5ml
-Ana-Te vaccine dose repeated after 2 weeks
-Ana-Te vaccine dose repeated after 4 weeks after
the second dose
-Ana-Te vaccine re-dose (booster dose) after 1st
year and it ensures a five-year immunity

BLEEDING
Kenan Karavdi, Assistant
Professor

BLEEDING
Bleeding is called every exit of blood from the

blood vessels.
According bleeding time
- primary (occurs immediately after the injury)
- secondary (occurs after a certain time of the
injury or, after establishing hemostasis)
According to distinguish the cause
-traumatic hemorrhage caused by mechanical injury
of blood vessels,
- bleeding due to disease (e.g., blood clotting
disorder, etc.).
According the place of bleeding distinguish:
-External bleeding - visible bleeding from the wound
- Internal bleeding - a result of injuries to internal
organs, when blood accumulates in the cavity

BLEEDING

By type of damaged blood vessels with external

bleeding distinguish:
Arterial bleeding - blood from the wound comes
out in a jet and bright color. It often occurs as a
pulsating bleeding. The most dangerous is
because it suddenly comes out a large amount of
blood.
Bleeding from veins - the blood is dark red, no
pulsations, flows evenly over the edge of the
wound.
The arterial and venous - bleeding at
simultaneous injuries of arteries and veins.
Capillary bleeding - it is a little bleeding, which
stops spontaneously to form a scab.

Emergency medical help

(EMH)
The person should be placed in the supine position,
preferably with legs and hands elevated
When stopping bleeding injured extremity should be
kept in an elevated position. The pressure on the
artery (digital compression)
Bleeding on the head and extremities can be
effectively stopped by pressing the artery that brings
blood to the injured area.
For this the procedure required skills and knowledge
of exactly place what needs to be pressed. Place of
pressure is always located between the heart and the
injured areas (wounds)

Bleeding Control

Control Methods For External

Bleeding:
Direct pressure most stops bleeding.
Wear medical exam gloves (if possible)
Place a sterile gauze pad or a clean cloth over
wound

Elevation injured part to help reduce blood

flow.
Combine with direct pressure over the wound
(this will allow you to attend to other injuries or
victims).

If bleeding continues, apply pressure

at aPlanning
pressure
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Emergency medical help

(EMH)
The process of stopping the bleeding artery with fingers
pressed to the bone underlying
It should never be simultaneously press both of the
cervical arteries.
The pressure on the wound can be carried out and a
piece of sterile gauze over that firmly pressed the
bleeding.
If the wound is on an arm or leg, raise the injured
extremity and held in an elevated position.
When bleeding progresses sure the digital compression
must be replaced by applying sterile gauze or specially
prepared compression bandages with pads. This is
carried out exclusively selective compression

Emergency medical help

(EMH)
dressings
Early compressive garment to be pressed in the following
manner:
The wound is placed sterile gauze
Directly over the place bleeding in gauze bandages put
packing
circular bandage tightly attract gauze and knot is placed
over the wound
Dressings should not be too tight (must not prevent the
flow of blood in the field below bend). Therefore, after
setting the compressive bandage must be checked pulse
and color limb lower than the compressive bandage,
Dressing never sets in the neck

Emergency medical help

(EMH)
In certain situations of deep wounds that are bleeding
(within the muscle lodge) it is useful to apply tamponade
the wound when the wound that bleeds insert a sufficient
number of tampons (the exact number recorded) and then
applied over the wound compression bandage.
When used hemostatic forceps / ligature should be
taken to set up secure enough, but also that not destroys
and sound segment of the vessel because it was in collision
with subsequent surgical reconstruction.
Early was then placed sterile gauze, so-called first bend.
If a limb, it should be immobilized, and the injured as soon
translate to the hospital. Any more extensive wounds must
be primarily processed in the first six to eight hours of injury

Use of tourniquet

If none of these methods is ineffective and it is a life-threatened

wounded amputees indicated the use of (tourniquet) or tubal
extremities. Properly set up it could save your life or threatens the
vitality of the extremities because induces circulation below the
ligation sites. Ligating the extremities may be applied only in
cases of:
amputation injury (avulsion or cutting off part of the hands or feet)
if you do not expect a reunion separate part of the extremities
(replantation),
strong contusions and crushing limbs when his inevitable loss,
heavy bleeding that can not be stopped by any other method and
the life of the injured is in danger.
For ligation using dedicated produced a wide rubber band or cloth
tape with buckle
- Esmarch, but can also serve triangle scarf complex to the width
of five centimeters,
tie or a thick rope. Do not use thin materials because they can
incise the tissue.

Internal bleeding
A / Internal bleeding with the release of blood on
the body openings
Bleeding from the respiratory tract
Hemoptysis is throwing through the mouth more or less
the amount of blood that comes from the respiratory
tract. Can be due to relatively harmless conditions
(bronchitis, epistaxis) but also serious diseases
(pulmonary tumors, tuberculosis). Depending on the
abundance of bleeding hemoptysis is divided into a
-massive (100 ml.krvi / hour),
-moderate (below 20 ml. of blood / h)
-minimum haemoptysis

Bleeding from the respiratory

tract
The treatment consists in the maintenance of
normal respiration and circulation
The patient should be placed in a semi-reclining or
sitting position, if known source of bleeding or
implement a strong suction of blood
Warn patients to strictly stationary, does not
speak, breathe shallowly and refrain cough
Measure the pulse and pressure
Prepare an accessory for use oxygen (5-10 l. /
Min), and IV therapy (infusion of isotonic solutions
of electrolytes)
When the bleeding stops the patient must rest in
bed for 48 hours. Observe it and avoid anything

Epistaxis
The primary causes of nosebleeds can be a injuries of the nose,
acute, and chronic atrophic inflammation of the nose, work by
irritating agents (acids and strong bases, various dust), tumors of
the nose.
In most cases, the bleeding is caused by rupture arterial-venous
capillary blood vessels mucous membranes lining the nasal
septum (Kiesselbach region). About 5% of cases the bleeding
comes from party nose that examination can not see.
Symptomatology
Bleeding can occur with many other general illnesses
inflammation (measles, scarlet fever, diphtheria, whooping
cough, influenza, malaria, typhoid, etc.), arterial hypertension,
heart failure with venous stasis, liver cirrhosis, some blood
diseases. Bleeding usually occurs suddenly.

Epistaxis
Patients who are bleeding at the nose are usually
very scared and is, in terms of providing
assistance, primarily need to calm patient, firmly
pinch the nose, tilt the head forward of patients,
and the back of the head
A cold compress by tilting the head forward with
pressed nostrils 10 minutes prevents the swelling
of the blood in his mouth, and at the same time
forms a clot that acts as a kind of tampons .
Breathing is done through the mouth. If after that
bleeding does not stop, the patient should be
taken to the hospital, where will he do front or
rear nasal packing. After the committed front
tamponade not need hospital treatment and the

Bleeding from the gastrointestinal tract

The most common clinical manifestation in the gastrointestinal (GI) bleeding:
Hematemesis - vomiting bloody or dark brown contents, most often
associated with bleeding fromthe upper part of the digestive system
(proximal to the ligament of Treitz).
Melena - black, tarry stool that usually means bleeding from the upper
gastrointestinal tract, ie of the esophagus, stomach or duodenum (the
hemoglobin under the influence of the HCl is converted into s hematin). For
the occurrence of melena a minimum around 60 ml. blood in the stool. It can
be replaced with black stool after taking the preparation of iron, bismuth, or
certain foods (blueberries, blackberries).
Haematochezia - passage of bright red blood through the rectum and
usually a sign of bleeding from the lower gastrointestinal tract (distal to the
ligament of Treitz). It can also occur when very massive bleeding and from the
upper GI tract.
Data on the repeated rectal bleeding suggests hemorrhoids, diverticulosis,
and intestinal polyps, changes caliber chairs on bowel cancer, stomach pain
with bleeding on ischemic colitis, and frequent bloody chairs in inflammatory
bowel disease

Bleeding from the

gastrointestinal tract
Reasons bleeding of upper gastrointestinal tract consisting of 80% of GI bleeding. Usually are:
-Ulcers of the stomach and duodenum (consisting of more than 50% of bleeding from the upper GI
tract),
-Erosion -superficial mucosal lesions that do not cross the muscularis mucosa (usually the stomach
and duodenum)
-Esophageal varices,
-Mallory-Weiss syndrome (laceration in the area gastroezofaringealnog compound after vomiting there
is a possibility of bleeding,
-Hematobilija (bleeding from the biliary tract due the existence of a vascular-bile leakage as a result of
trauma, liver biopsy, cancer, aneurysm
-Urgent medical assistance (hepatic artery, gallstones or liver abscess),
-neoplasms (mostly in major damage
-blood vessels in the upper GI tract) and others.
+ UMP
Place a nasogastric tube,
provide iv. portals and proceed with the replacement of circulating volume.
Patient in a horizontal position - Autotransfusion position
urgent referral to a hospital.
For active stop bleeding it is necessary to specify the location of the bleeding, the lesion that bleeds
and other bleeding (arterial, vein, capillary). This is achieved by various diagnostic procedures.

Internal bleeding without leaving

blood on the body openings
B / Internal bleeding without leaving blood on the body

openings
At every substantial impact in the hull (eg. In a car
accident) must suspect the possibility internal injuries with
bleeding into the abdominal or chest cavity, even when
injured feels relatively well and there are no visible injuries.
Internal bleeding can be very treacherous, with the first
clinical manifest signs only after several hours.
Bleeding into the free abdominal cavity (see abdominal
injury)
Bleeding into the chest cavity is accompanied by shortness
of breath (see hemothorax)
Bleeding into muscles (muscle Lodge) occurs at the turn of
the large bones (thigh or upper arm bones), when sharp
bone fragments may hurt the blood vessel and cause
profuse bleeding. Injuries of blood vessels may occur at the

Bleeding Control Cont.

Control Methods For Internal

Bleeding:
Signs of internal bleeding:

Bruises or contusions of the skin

Painful, tender, rigid, bruised abdomen
Vomiting or coughing up blood
Stools that are black or contain bright red blood

What to Do:
For severe internal bleeding, follow these
steps:
Monitor ABCs (Airway Breathing Circulation)
Keep the victim lying on his/her left side. (This will
help prevent expulsion of vomit from stomach, or
allow the vomit to drain and also prevent the victim
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Craniocerebral injuries
and
disturbance of
consciousness
Kenan Karavdi

Craniocerebral injuries and

disturbance of consciousness
Head injury is a general term used to describe any kind of head
trauma, or more specifically, the brain.
The hard, thick bones of the skull, protects the brain. Despite
this natural protection of the brain can be hurt.
Head injuries kill or disable more people under the age of 50
years and after wound default firearms second leading cause
of death in men younger than 35 years. Nearly half of people
with severe head injuries dies. The brain can be damaged even
if the bone is not broken. Many injuries are caused by sudden
acceleration, the acceleration following the rejection, for
example, after a sharp blow to the head; or sudden
deceleration when the head hits a stationary object.
Acceleration-deceleration injuries are also called "coup /
countercoup", as the French term for attack and counter-attack

Craniocerebral injuries and

disturbance of consciousness
Craniocerebral injuries are divided into:
- injures of the scalp (abrasions, contusions, cuts, lacerations,
puncture wounds)
- injuries of the bone of the skull vault (in-line, and comminuted
fractures of the skull and impressive fractures of the vault and
skull base)
- injuries of intracranial structures (concussion, contusion of the
brain, epidural, subdural, intracerebral and intraventricular
hemorrhage)
According to the character of the injury can be:
-open and closed (closed if not undermined the integrity of the
skin, subcutaneous tissue and periosteum)
- nonpenetran and penetrating (in penetrating injury of a injuries
envelope -Hard brain meninges)

Linear fracture of the skull

Fracture of the skull - a break with the bone that surrounds the
brain and other structures within the skull.
- Linear fracture of the skull - a simple fracture of the skull,
which is mainly in the form of a relatively straight line. It may
occur after seemingly minor head trauma (a blow on the head,
for example, stone, stick or other object, the result of traffic
injuries). A linear skull fracture is not a serious injury, unless
there are other impairments; blood vessels, brain and long
structures in the skull.
- Fracture of skull base resulting from blunt trauma of injures
bones which form the base of the skull. These fractures are
often connected with the sinus cavity. Such communication can
cause penetration of microorganisms into the skull and
infection. Surgical intervention is not needed if there are no
other injuries.

Impressive skull fracture (fracture

of the bone fragment imprinted
common after a strong attack with blunt objects.
These pieces cause "holes" in the skull with the
imprint bones. If the depth of imprints at least
equal to the thickness of the surrounding bone, it
is often necessary to do the surgery in order to
raise the embedded bone chips and examined
the brains for possible violations. Minimum
imprints bones are smaller than the thickness of
the bone. Some fractures are not at all
impressed. Usually do not require surgery unless
they saw other injuries.

Fracture of skull base

resulting from blunt trauma of injures
bones which form the base of the
skull. These fractures are often
connected with the sinus cavity. Such
communication
can
cause
penetration of microorganisms into
the skull and infection. Surgical
intervention is not needed if there
are no other injuries

Injuries of intracranial
structures
Earthquake (commotion) of the brain is one of the primary brain
damage. Specifically in the brain stem hurt small part of brain cells
that are by their nature can not be renewed. Manifested amnestic
syndrome or loss of consciousness for a short period before the
injures (retrograde amnesia) and outage memories for itself a
injures. To qualify as grievous bodily harm. already after a few hours
or days (1-2 days) the patient is quite good.
Contusion of the brain, the anatomical brain damage with
destruction of cells, bleeding and subsequent swelling of the brain.
Lacerations of the brain produced by direct trauma of the brain
and may be associated with the fallout of the brain tissue through
the open tissue that protects the brain (brain prolapse).
Symptomatology is similar to concussion. Contusion usually
requires no intervention

Intracranial hemorrhage
Epidural hematoma is bleeding between the dura mater
and the bones of the skull: occurs when the middle meningeal
artery ruptures (a. Meningea media). It is usually a result of
injuries temporal, frontal and occipital region of the head. It
occurs in between 0.4 and 5% of all head injuries, and in 90%
of cases associated with fractures of the skull.
The typical image epidural hematoma is head trauma with
symptoms of concussion, or without, followed by a period with
no evidence of disease (lucid interval) as well as employers
severe headache, motor disorders, seizures, absence of
pupillary reflex and secondary loss of consciousness.
This condition is very serious and often require emergency
surgery

Intracranial hemorrhage

Subdural hematoma which is bleeding

between the soft and the dura mater Due to
expansion and rupture of veins. The
hematoma may be acute, suddenly, after an
injury or chronic as accumulation over a long
period of injury. Occasionally subdural
hematoma often occurs in older people whose
veins are stretched and fragile and break
easily and after trivial injuries. This type of
bleeding is potentially dangerous and often
require emergency surgery.

Intracranial hemorrhage
Intraparenhim
(intracerebral)
bleeding is a collection of blood in the
brain tissue. Minor bleeding may stop
without any treatment and usually do
not cause more problems. Larger and
more
serious
bleeding
requiring
surgery. If the bleeding is present in
the brain chambers then we speak of
intraventricular hemorrhage.

Stroke (Brain Attack)

What is Stroke?
Tissue damage
to area of the
brain due to
disruption in
blood supply,
depriving that
area of the brain
of oxygen.
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Stroke (Brain Attack) Cont.

Signs and Symptoms of Stroke:
Weakness or numbness of the
face, arm, or leg (usually
on one
side of the
body)
Blurred or decreased vision,
especially in one eye.
Problems speaking or
understanding
Unexplained, severe headache
Dizziness, unsteadiness,
or sudden fall
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Intracranial hemorrhage
Based on the description of the situation in which
the infringement and views injured sets of
suspected head injury or diagnosis if the injury is
verified.
Skull fracture is proved by X-ray examination.
If a suspected brain injury are essential CT scan or
MRI if it is to perform radiographic assessment of
severity of soft structures within the skull.

If the suspicion of bleeding can be done

angiography.
Additional
time
is
determined
depending on the condition of the patient and any
other injuries.

Amnestic syndrome (organic

amnesia)
The organic amnesia occurs most often due to damage to the deeper brain structures or brain cortex, and
after injuries (concussions, contusions or contusions of the brain), strangulation, and the failed hanging, after
severe poisoning, epileptic seizure, delirium and blurred consciousness, twilight conditions, disorders of
cerebral circulation or degenerative changes of certain parts of the brain.
The most common, caused by organic amnesia occurs after a head injury - the so-called. posttraumatic
amnesia. A common after suffering a concussion or contusion of the brain. If the person can not recall the
events immediately prior to the injury, ie. trauma, we are talking about - retrograde amnesia.
It covers different long period before the occurrence of the injury, usually a few seconds or minutes, rarely
longer. Retrograde amnesia refers to the fact that even after completing the process of observation for some
time continues so. and brain process - "the stabilization or fixation time", it is necessary to create engrams,
or fix the image memories.
If a person after a head injury act consciously and talk, but after these events do not remember, it's about anterogradnoj amnesia. These people are not able to remember new events.
This form amnenzije covers certain period and after the apparent return of consciousness and making
contact with the environment. The most commonly seen after suffering earthquake or contusions of the
brain, when it can be combined with retrograde amnesia. And anterograde amnesia caused by the inability to
create images and memories of their retention. This form of amnesia is one of the reliable criteria for
assessing the severity of the impairment or brain injury.
In these cases it is short-term memory impairment that is characterized by damage to the storage and
playback of new knowledge. In this function are necessary and proper registration of short-term storage of
new knowledge. In the storing and reproduction of knowledge play an important role brain structure below
the cerebral cortex, limbic structures that we call, zatimhipokampus, mammary bodies and dorsomedial
nucleus of the thalamus. Damage to these structures caused by the inability to store new material
(anterograde amnesia) or remembering

Quantitative disturbances of
consciousness;
Somnolence was the mildest quantitative disturbance of
consciousness. A man in a state of somnolence seems sleepy,
apathetic, inert. The perception of stimuli is possible, but only if
it is a more intense stimulus. Patients are difficult bind attention
to an object or phenomenon. Insecure are oriented in space and
time.
Sopor is the state with the altered stream of consciousness
and amnesia performances or hurt only partially recalled the
event. Soporozni patient weight responds to external stimuli.
With him is very difficult or almost impossible to establish verbal
contact.
Coma is the hardest quantitative disturbance of consciousness.
Patients in the most difficult level of which, do not respond to
any stimuli. Were shut down miotatiki reflexes and reflex pupil
to light. Stream of consciousness is completely broken.

Qualitative disorders of
consciousness;
Confusing-Oneiroid situation has much in common with
a dream. The condition is characterized by an uncertain
orientation of the patient. The patient operates selfconsciously and confused, difficult to recognize people and
objects around them, often wanders, has expressed feelings
of insecurity and uncertainty. Patients are highlighted
malleable affect their liability. This disturbance of
consciousness usually has an underlying organic
pathological change,but sometimes the condition can occur
in response to a stressful situation.
Delirium is a second basic acute brain syndrome or
disorder that occurs as part of an organic disorder. Delirium
syndrome consists of several basic symptoms: space-time,
as well as auto - (towards you) and allopsychic (to others)
disorientation, then sensory deception types of illusions and
hallucinations, which are usually unpleasant content, fear
that occurs in response to unpleasant and frightening

Qualitative disorders of
consciousness

Twilight state is a form of disorders of consciousness in which he

held an awareness of the environment and objects, but loses
awareness of his own too. The internal mental functions are most
orderly, so the patient is not showy environment. On the contrary
able to perform some actions. However, the patient can not "see"
himself, knows what he is doing, or why it works. Consciousness is
very limited, and mental life takes place in the lower layers of
personality. This condition usually occurs quickly, but also
suddenly and disappears. The most common cause is epilepsy.
Somnambulism or sleepwalking is characterized by loss of
control of motor activity. Such a loss of control occurs when
consciousness is altered state of sleep and motor activity returns
to the "activities", before consciousness again "activated".
Sleepwalking may be a manifestation of epileptic damage, but
may occur as a conversion syndrome neuroses.
Fuga This term is named from the Latin word fugue, which means
escape. It is a disorder of consciousness, which, as the name
states, characterized in that the patient no apparent reason

Glasgow
GCS

Coma

Scale

Glasgow coma scale (Glasgow Coma Scale - GCS) is a scoring system

used to evaluate the level of awareness among the people immediately
after brain injury. It is today the world's most widely used Neurological
Scale.
GCS is measured from 3 to 15, where 3 denotes the worst response (deep
coma), and the 15 best (patient fully conscious).
The scale is obtained by summing the values of three parameters: the
best ocular response with the highest values of 4, the best voice
response with a maximum value of 5, and the best motor response with
the highest value 6th
Answers will be settled as follows:
Best eye response (About)
1. Do not open your eyes
2. sight to the pain stimulus
3. eye opens to a voice command
4.spontaneously opens eyes

Glasgow Coma Scale GCS

The best verbal (spoken) response
1. no voice response
2 corresponds unintelligible sounds
3. corresponds meaningless words
4. responses confusing
5. convenient oriented
Best motor response (M)
1. no motor response
2. corresponds to the extension of a painful stimulus (ie. Decorticatio
answer)
3. flexion corresponds to painful stimuli (ie. Decelebracion answer)
4. moving away from the painful stimulus
5. localized pain stimulus
6. monitoring commands

Glasgow Coma Scale GCS interpretation of

results

heavy, i GCS 8,
medium heavy, if the GCS 9-12
shallow, if GCS 13th

TREATMENT
In all affected patients assistance is provided always in place
of injury and continuing during transport to a medical facility.
It includes: the maintenance of a patent airway, stop
bleeding, placing the patient in the proper position,
oxygenation, assessment of the state of consciousness and
transport to the hospital.
Of MHI if a subcutaneous bleeding or swelling can be put ice,
but not directly on the skin. Ice can be placed during 20-30
minutes and may be repeated every 2-4 hours as needed.
The injured is an urgent need to take to a doctor if there is:
loss of consciousness, fell awkwardly or heavy blow, even if
there is no loss of consciousness, vomiting, confusion,
drowsiness, weakness or inability to walk, severe headache.

Chest injuries
Kenan Karavdi, Assistant
Professor