Blunt trauma là gì

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StatPearls . Treasure Isl& (FL): StatPearls Publishing; 2021 Jan-.


Continuing Education Activity

Traumatic Brain Injury is a significant cause of morbidity và mortality in the United States, with an annual occurrence of more than 1.5 million. Falls are the most common cause of traumatic brain injury, và motor vehicle-related incidents are the second leading cause. Blunt head trauma is classified as mild, moderate, or severe traumatic brain injury. This activity describes the etiology, classification, pathophysiology, evaluation, & management of blunt head trauma and highlights the role of interprofessional teams in improving outcomes for such patients.

Describe the etiology, epidemiology, pathophysiology, and classification of patients with blunt head trauma.
đánh giá the conservative & surgical treatment options available for patients with blunt head trauma.
Explain interprofessional team strategies for enhancing care coordination khổng lồ facilitate rapid diagnosis and targeted management of patients with blunt head trauma.


Traumatic Brain Injury (TBI) is a significant cause of morbidity and mortality in the United States, with an annual occurrence of more than 1.5 million. Patients with moderate và severe TBI comprise about 20% of TBI, & those with moderate TBI have sầu a mortality of about 15% while those with severe TBI have associated mortality approaching 40%. The majority (approximately 80%) of patients with TBI have mild TBI which is associated with a less than 0.5% mortality, but about 25% experience extended post-concussive sầu symptoms including a headabít, dizziness, difficulty concentrating, và depression. <1><2><3>


Falls are the most common cause of TBI, & motor vehicle-related incidents are the second leading cause of TBI. Motor vehicle-related TBI includes autoMobile, motorcycle, and bicycle accidents và pedestrians struông chồng by those vehicles. Sports, recreation, và work-related injuries are the third leading cause of TBI, & assaults are the fourth leading cause of TBI. Blast injuries are the leading cause of TBI in active sầu duty military personnel in war zones.

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TBI is the most common cause of death in people younger than the age of 25. The majority of fatal TBI is due khổng lồ motor vehicle-related incidents, falls, & assaults. Mortality due to lớn motor vehicle accidents is greademo in the young-adult age group attributed to alcohol use và excessive tốc độ. Mortality due khổng lồ falls is greathử nghiệm in patients over age 65, which is also the age group with the highest mortality in any TBI. Neurosurgical intervention such as craniotomy, elevation of skull fracture, intracranial pressure (ICP) monitor, or ventriculostomy is required in about 40% of patients with severe TBI & about 10% of patients with moderate TBI.  <7><8>


Most patients with moderate lớn severe TBI have sầu a combination of intracranial injuries. The majority of patients with moderate khổng lồ severe TBI have related diffuse axonal injury khổng lồ some degree. The diffuse axonal injury typically is caused by a rapid rotational or deceleration force that causes stretching and tearing of neurons, leading to focal areas of hemorrhage and edema that are not always detected on the initial computed tomogram (CT) scan. Subarachnoid hemorrhage (SAH) is the most comtháng CT finding in TBI & is caused by tears in the pial vessels. Subdural and epidural hematomas are the most frequent type of mass lesion identified in TBI. Cerebral contusions occur in about a third of patients with moderate to severe TBI, caused by direct impact or acceleration-deceleration forces that cause the brain to lớn strike the frontal or temporal regions of the skull. Intracerebral bleeding or hematoma, caused by coalescence of contusions or a tear in a parenchymal vessel, occurring in up khổng lồ a third of patients with moderate khổng lồ severe TBI.  <9><10>

History and Physical

The majority of patients with TBI have a straightforward clinical presentation, but it is also important khổng lồ solicit the mechanism of injury, current anticoagulation use, symptoms of the head or neông chồng pain, post-traumatic seizure, and any history of repeat head injury or past central nervous system surgeries.

The initial resuscitation should proceed in a step-wise fashion lớn identify all injuries and optimize cerebral perfusion by maintaining hemodynamic stabilization & oxygenation. The initial survey also should include a brief, focused neurological examination with attention lớn the Glasgow Coma Scale (GCS), pupillary examination, and motor function.

After addressing any airway or circulatory deficits, a thorough head-to-toe physical examination must be performed with vigilance for occult injuries and careful attention khổng lồ detect any of the following warning signs<11>:

Fundoscopic examination for retinal hemorrhage (a potential sign of abuse in children) và papilledema (a sign of increased ICP)
Optic nerve sheath diameter of greater than 5 mm on ultrasound has been shown lớn correlate well with increased intracranial pressure in patients with TBI
Palpation of the scalp for hematoma, crepitus, laceration, and bony deformity (markers of skull fractures)
Auscultation for carotid bruits, painful Horner syndrome or facial/neông chồng hyperesthesia (markers of carotid or vertebral dissection)
Evaluation for cervical spine tenderness, paresthesias, incontinence, extremity weakness, priapism (signs of spinal cord injury)


Non-contrast cranial CT is the imaging modality of choice for patients with TBI. CT findings associated with a poor outcome in TBI include midline shift, subarachnoid hemorrhage into the verticals, và compression of the basal cisterns. Magnetic Resonance Imaging scan may be indicated when the clinical picture remains unclear after a CT khổng lồ identify more subtle lesions.<13><14>

Treatment / Management

Airway adjuncts are indicated in patients not able to lớn maintain an open airway or maintain more than 90% oxygen saturation with supplementary oxygene. Oxygenation parameters should be monitored using continuous pulse oximetry with a target of more than 90% oxyren saturation. Ventilation should be monitored with continuous capnography with an end-tidal CO2 target of 35 mmHg lớn 40 mmHg. Placement of a definitive airway is recommended in the patient with a Glasgow Coma Scale (GCS) score of less than 9.  <15>

Systemic hypotension negatively impacts the outcome in the setting of TBI, and current studies have demonstrated improved outcomes in patients with systolic blood pressure (BP) greater than or equal to 120 mmHg. Isotonic crystalloids should be used to prsự kiện và correct hypotension; colloidal solutions have not been shown lớn improve sầu outcomes.

Serial neurological examinations allow for early identification of patients with elevated ICP, và subsequent implementation of primary bedside interventions to lớn improve venous outflow and reduce metabolic demands. Initial bedside approaches to lớn increase ICP include elevating the head of the patient"s bed 30 degrees, ascertaining that the cervical collar is not impeding venous outflow, & appropriate analgesics và sedation.

Routine hyperventilation should be avoided during the first 24 hours, and should only be used as a temporizing measure in the setting of impending herniation. Hyperosmolar therapy such as mannitol or hypertonic saline can further reduce intracerebral volume. ICP monitoring is indicated in patients with TBI when they have a GCS score of less than 9, an abnormal CT, và the approach to lớn refractory elevated intracranial pressure includes high-dose barbiturates và possibly a decompressive sầu hemicraniectomy.<16>