扬州大学：《外科学》课程教学课件（PPT讲稿，Surgery）Chapter 13. Craniocerebral Trauma（part two）

Craniocerebral Trauma

Craniocerebral Trauma

Summaryoflastclasso Pathogenesis;o Pathology,o Classification;o Radiographic Evaluation

Summary of last class  Pathogenesis;  Pathology;  Classification;  Radiographic Evaluation

Clinical Findings

Clinical Findings

SymptomsandSignsoInitialexamination（首先评估情况）initial general trauma assessment: ABCs (airway:breathing, and circulation)initial trauma neurologic examination: ABCDs (D isfor disability)

Symptoms and Signs  Initial examination（首先评估情况） initial general trauma assessment: ABCs (airway, breathing, and circulation). initial trauma neurologic examination: ABCDs (D is for disability)

Glasgow Coma Scale (GCS)o Coma: GCS<=8o Severe injury: GCS<=8o Moderate injury: GCS 9-12o Mild injury: GCS: 13-15

Glasgow Coma Scale (GCS)  Coma: GCS<=8  Severe injury: GCS<=8  Moderate injury: GCS 9-12  Mild injury: GCS: 13-15

Cranial nerve and reflex assessmentso Depend on patient's level of consciousness.oAwake（清醒检查）oCmoa（昏迷检查）o Three reflexes: the pupillary reflex; the cornealreflex, the gag reflex

Cranial nerve and reflex assessments  Depend on patient’s level of consciousness.  Awake（清醒检查）  Cmoa（昏迷检查）  Three reflexes: the pupillary reflex; the corneal reflex; the gag reflex

Continue...o The pupillary reflex: information via cranial nerveII (optic nerve), and nerve III (oculomoter)o Localizing in the midbraino A unilaterally dilated or fixed pupil in the comatosepatient is of considerable concern as it often indicatestranstentorial herniation of the ipsilateralhypertension

Continue.  The pupillary reflex: information via cranial nerve Ⅱ(optic nerve), and nerve Ⅲ (oculomoter).  Localizing in the midbrain.  A unilaterally dilated or fixed pupil in the comatose patient is of considerable concern as it often indicates transtentorial herniation of the ipsilateral hypertension

Continue...o The corneal reflex: information via cranial nerve V(ophthamic portion of trigeminal nerve), and nerve VII(facial).o Localizing in the ponso The loss of the corneal often indicates severe brainstem injury

Continue.  The corneal reflex: information via cranial nerve Ⅴ (ophthamic portion of trigeminal nerve), and nerve Ⅶ (facial).  Localizing in the pons.  The loss of the corneal often indicates severe brain stem injury

Continue...o The gag reflex: afferent and efferent signals arecarried via the glossopharyngeal (IX) and vagus (X)nerves.o Localizing in medullao The loss of gag reflex indicates severe brain steminjury

Continue.  The gag reflex: afferent and efferent signals are carried via the glossopharyngeal (Ⅸ) and vagus (Ⅹ) nerves.  Localizing in medulla.  The loss of gag reflex indicates severe brain stem injury

AssessmentofmotorfunctionMotor Scoring SystemGradeDescription0Nomuscle contraction1Visible muscle contraction without movement across the joint2Movement in the horizontal plane, unable to overcome gravity3Movement against gravity4Movementagainstsomeresistance5Normal strength

Assessment of motor function Motor Scoring System Grade Description 0 No muscle contraction 1 Visible muscle contraction without movement across the joint 2 Movement in the horizontal plane, unable to overcome gravity 3 Movement against gravity 4 Movement against some resistance 5 Normal strength