Slow heartbeat and pulse, slowed breathing rhythm, and elevated blood pressure (also known as "two slow and one high")

Chronic patients - apathetic and unresponsive

Acute patients - progressive disorder of consciousness

Double vision, dizziness, cataplexy, Children may have enlarged heads and widened cranial sutures, etc.

Tentorial notch herniation

foramen magnum hernia

Lying position: Elevate the head of the bed 15°~30° to facilitate intracranial venous return

oxygen

Diet and rehydration: The daily rehydration volume for adults is limited to 1500-2000ml (including no more than 500ml of saline solution)

Strengthen daily care

1. For high fever, physical cooling methods such as ice caps, ice packs or towels with ice water are commonly used. 2. Agitation. Give sedatives if necessary. Forced restraint is contraindicated. 3. Vomiting to prevent aspiration, observe and record the amount and characteristics of vomitus 4. For headaches, give sedatives and analgesics, but morphine and pethidine are prohibited. 5. Urinary retention: Inducing stimulation of urination, ineffective catheterization

state of consciousness

Cerebral herniation: Symptoms such as severe headache or irritability during the observation period may be a precursor to increased intracranial pressure.

1. Bed rest 2. Keep the respiratory tract open 3. Avoid severe coughing and straining to defecate 4. Control epileptic seizures

20% mannitol 250ml, rapid intravenous infusion within 15 to 30 minutes

Prevent and treat cerebral edema by improving blood-brain barrier barrier permeability It is advisable to use it for a short period of time as soon as possible, and pay attention to preventing infection and stress ulcers.

1. Properly fix the drainage tube. The drainage bag is hung at the head of the bed, 10~15cm above the level of the lateral ventricle. 2. Control the drainage speed and volume to <500ml per day 3. Keep the drainage smooth and can be suctioned, but do not flush with salt water. 4. Observe and record the color, amount and nature of drainage fluid 5. Strictly abide by the principles of aseptic operation 6. Extubation and drainage time are generally 1 week, and drainage should not exceed 3-4 days after craniotomy. Before extubation, perform a head CT examination and clamp the tube for 1 day to observe the condition.

Physical cooling is suitable for reducing body temperature by 1°C per hour. It is ideal for the body temperature to drop to anal temperature of 32~34°C and axillary temperature of 31~34°C. First use hibernation medicine (the cold response disappears and you enter a comatose state), and then physically cool down. The duration of hibernation hypothermia therapy is generally 3 to 5 days. When terminating hibernation, first stop physical cooling and then stop medications.

Subcutaneous hematoma: The hematoma is not easy to spread, is small in size, and has obvious tenderness. Characteristics: small and localized, high tension, obvious pain, and no fluctuation.

Subgaleal hematoma: The tissue is loose, the hematoma spreads easily, the pain is not as obvious as subcutaneous hematoma, and the blood loss is large Characteristics: The hematoma has a wide range and can spread to the whole head, with low tension and obvious fluctuations.

Subperiosteal hematoma: The hematoma is limited to one part of the skull. The hematoma is hypertonic. Characteristics: The scope of the hematoma does not exceed the cranial sutures, and the tension is high. In large cases, there may be a fluctuating sensation, often accompanied by skull fractures.

Processing principles Small hematoma It will be absorbed by itself in 1-2 weeks; be rigorous and conscientious Generally, no puncture is required to draw fluid to avoid infection, and no special treatment is required. Large hematoma Early pressure bandaging and local cold compress can reduce bleeding and pain. Hot compress after 24-48 hours can promote hematoma absorption. It usually takes 4-6 weeks to be absorbed. The huge hematoma was punctured in stages to extract the accumulated blood and then bandaged under pressure.

deal with Stop bleeding as soon as possible and bandage the wound with pressure Perform debridement and suturing as soon as possible (within 24 hours) Anti-infective

Severe scalp injury, large avulsion area, may cause blood loss sexual or painful shock

First aid: pressure bandage to stop bleeding, relieve pain, and resist shock

Treatment principle: If the injury is not completely avulsed, try to debridement and suture it back to the original location within 6-8 hours after the injury.

open fracture

closed fracture

skull fracture

skull base fracture

direct damage

indirect damage

rotational injury

concussion

brain contusion

brainstem damage

Brain edema

intracranial hematoma

Cerebral herniation