{"id":1384,"date":"2016-11-23T15:24:28","date_gmt":"2016-11-23T17:24:28","guid":{"rendered":"http:\/\/srv150.prodns.com.br\/~fisiocti\/site\/?p=1384"},"modified":"2022-04-25T12:44:24","modified_gmt":"2022-04-25T15:44:24","slug":"traumatismo-cranioencefalico","status":"publish","type":"post","link":"https:\/\/fisiocti.com\/site\/traumatismo-cranioencefalico\/","title":{"rendered":"Traumatismo Cranioencef\u00e1lico"},"content":{"rendered":"

O traumatismo cranio encef\u00e1lico (TCE) \u00e9 definido como qualquer les\u00e3o do cr\u00e2nio e do enc\u00e9falo. Ela pode ser por causas Prim\u00e1rias (eventos mec\u00e2nicos, como for\u00e7as de acelera\u00e7\u00e3o, desacelera\u00e7\u00e3o, rotacionais, penetrantes e contusas que ocorrem no momento do impacto) ou Secund\u00e1rias (podem ocorrer do momento do evento inicial at\u00e9 minutos, horas e at\u00e9 dias depois da les\u00e3o prim\u00e1ria).<\/p>\n

O Exame F\u00edsico envolve basicamente o ATLS, por\u00e9m devemos sempre ficar atentos ao:<\/p>\n

– Reflexo Pupilar
\n– Piramidalismo
\n– Evid\u00eancia de fratura de base de cr\u00e2nio (Sinal do Guaxinim e Sinal de Battle)
\n– Rino\/Otorr\u00e9ia de l\u00edquor
\n– Otorragia<\/p>\n

CLASSIFICA\u00c7\u00c3O<\/strong><\/p>\n

\"glasgow\"<\/p>\n

O m\u00e1ximo da pontua\u00e7\u00e3o \u00e9 15 pontos e o m\u00ednimo \u00e9 3.<\/p>\n

TCE Leve \u2013 13 a 15
\nTCE Moderado – 9 a 12
\nTCE Grave \u2013 3 a 8<\/p>\n

Se liga no Bizu (1)<\/strong>:<\/em> N\u00e3o se aplica a Escala de Coma de Glasgow para pacientes sedados. Mais informa\u00e7\u00f5es no nosso post Glasgow x Ramsay x RASS<\/p>\n

Se liga no Bizu (2):<\/em><\/strong> Epis\u00f3dio de Hipotens\u00e3o dobra a gravidade<\/p>\n

TIPOS<\/strong><\/p>\n

Fraturas da Base do cr\u00e2nio – \u00e9 uma fratura linear que se estende \u00e0 fossa craniana anterior, m\u00e9dia ou posterior da base do cr\u00e2nio. \u00c9 dif\u00edcil de visualizar em TC e Rx Simples, sendo o diagn\u00f3stico cl\u00ednico! \u00c9 caracterizada por equimose periorbit\u00e1ria bilateral (Sinal do Guaxinim), rinorr\u00e9ia, equimose sobre o processo mast\u00f3ide atr\u00e1s da orelha (Sinal de Battle) e otorr\u00e9ia.<\/p>\n

<\/p>\n

<\/p>\n

Hematoma Subdural – hematoma intracraniano traum\u00e1tico mais comum e se origina de sangramento venoso causado por lacera\u00e7\u00e3o de veias-ponte no espa\u00e7o subdural entre a dura e adacn\u00f3ide.<\/p>\n

Hematoma Epidural – causado por sangramento arterial no espa\u00e7o epidural entre o cr\u00e2nio e a duram\u00e1ter, associa-se \u00e0 fraturas do osso temporal, causando lacera\u00e7\u00e3o da art\u00e9ria men\u00edngea m\u00e9dia. O sangue arterial rapidamente se acumula, e os pacientes podem deteriorar rapidamente (\u00e9 o \u201cconversar e morrer\u201d). N\u00e3o causada por les\u00f5es venosas.<\/p>\n

Hematoma Intracerebral – as hemorragias intraparenquimatosas s\u00e3o incomuns em trauma craniano n\u00e3o penetrante. Contus\u00f5es cerebrais que estejam aumentando de volume podem coalescer e formar francos co\u00e1gulos intraparenqiuimatosos que necessitam de cirurgia.<\/p>\n

S\u00edndrome da hernia\u00e7\u00e3o – desvio do tecido cerebral para a \u00e1rea anormal e \u00e9 secund\u00e1ria a diferenciais de PIC. A hernia\u00e7\u00e3o uncal \u00e9 quando temos o unco do lobo temporal herniando entre o tronco cerebral e a borda tentorial. Haver\u00e1 redu\u00e7\u00e3o da consci\u00eancia por compress\u00e3o da forma\u00e7\u00e3o reticular no TE, pupila ipsolateral dilatada por compressao do III par de nervos cranianos e hemiplegia contralateral por compress\u00e3o direta do ped\u00fanculo cerebral.<\/p>\n

DIAGN\u00d3STICO<\/strong><\/p>\n

a) Indica\u00e7\u00e3o de TC:
\n– Glasgow < 15
\n– Paciente alcoolizado ou drogado
\n– Perda objetiva da consci\u00eancia
\n– Evolui com mudan\u00e7as do Glasgow, cefal\u00e9ia progressiva e\/ou v\u00f4mitos inexplic\u00e1veis
\n– Cefal\u00e9ia refrat\u00e1ria ou de dif\u00edcil controle
\n– V\u00f4mito em jato ( n\u00e3o precedido de n\u00e1useas)
\n– Se houverem crit\u00e9rios de gravidade para o acidente
\n– Se houver fratura de cr\u00e2nio no Rx simples
\n– Se houver otorragia, oto e\/ou rinoliquorr\u00e9ia
\n– Apresentar um d\u00e9ficit neurol\u00f3gico central, crise convulsiva, sinal de Battle e\/ou do Guaxinim<\/p>\n

b) RNM
\n– D\u00e9ficit neurol\u00f3gico e se a TC for inocente<\/p>\n

TRATAMENTO<\/strong><\/p>\n

– Vias a\u00e9reas\/respira\u00e7\u00e3o – manter via a\u00e9rea aberta, desobstruindo-a e garantindo oxigena\u00e7\u00e3o.
\n– Circula\u00e7\u00e3o – controlar hemorragias externas, manter volemia do paciente. Se houver choque hipovol\u00eamico fazer reposi\u00e7\u00e3o intra-venosa agressiva de volume.
\n– Controle da PIC
\n– Seda\u00e7\u00e3o
\n– Controle da glicemia e temperatura
\n– Hiperventila\u00e7\u00e3o
\n– Craniotomia Descompressiva (para evitar hernia\u00e7\u00e3o)<\/p>\n

\"\"<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

O traumatismo cranio encef\u00e1lico (TCE) \u00e9 definido como qualquer les\u00e3o do cr\u00e2nio e do enc\u00e9falo. Ela pode ser por causas Prim\u00e1rias (eventos mec\u00e2nicos, como for\u00e7as de acelera\u00e7\u00e3o, desacelera\u00e7\u00e3o, rotacionais, penetrantes e contusas que ocorrem no momento do impacto) ou Secund\u00e1rias (podem ocorrer do momento do evento inicial at\u00e9 minutos, horas e at\u00e9 dias depois da […]<\/p>\n","protected":false},"author":1,"featured_media":1386,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[154,92,98,155],"tags":[70,119,118,57,84,117],"yoast_head":"\nTraumatismo Cranioencef\u00e1lico<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/fisiocti.com\/site\/traumatismo-cranioencefalico\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Traumatismo Cranioencef\u00e1lico\" \/>\n<meta property=\"og:description\" content=\"O traumatismo cranio encef\u00e1lico (TCE) \u00e9 definido como qualquer les\u00e3o do cr\u00e2nio e do enc\u00e9falo. Ela pode ser por causas Prim\u00e1rias (eventos mec\u00e2nicos, como for\u00e7as de acelera\u00e7\u00e3o, desacelera\u00e7\u00e3o, rotacionais, penetrantes e contusas que ocorrem no momento do impacto) ou Secund\u00e1rias (podem ocorrer do momento do evento inicial at\u00e9 minutos, horas e at\u00e9 dias depois da […]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/fisiocti.com\/site\/traumatismo-cranioencefalico\/\" \/>\n<meta property=\"og:site_name\" content=\"FisioCTI\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/fisiocti\/\" \/>\n<meta property=\"article:published_time\" content=\"2016-11-23T17:24:28+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2022-04-25T15:44:24+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/fisiocti.com\/site\/wp-content\/uploads\/2016\/11\/cranio0.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"693\" \/>\n\t<meta property=\"og:image:height\" content=\"693\" \/>\n\t<meta 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