Clinical Notes

The thoracic cage

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The skeleton of the Thorax is made up of bone and cartilage. The Thorax is a cone shaped cavity broader below then above and longer behind then in front.
it is formed by the twelve thoracic vertebrae at the back the sternum in front and the 12 pair of ribs at the sides which encircle the trunk from the vertebral Kollam behind to the the sternum in front.

damage to the contents of the skull in head injury

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any part of the brain may be injured. Indicates area of the cerebrum which may be affected giving rise to interference with moment ( the motor cortex) with sensation ( the sensory area) impairment of the the higher mental functions and emotions in the frontal lobe vision is the occipital lobe the speech mechanism memory and hearing the the temporal lobe injury to the internal capsule resulting in in disorders of moment and sensation. Any of the cranial nurves may be injured.
increase interracial pressure may be due to bleeding or to cerebral edema either may give rise to :

Cerebral comparison with loss of consciousness if full bonding pulse and hyperpyrexia, or
Cerebral irritation when the patient may be restless disorientatef and abusive.

edema may be treated by dehydrating drugs such as urea or mannitol Hexa nitrate.
Chest complications may occur necessitating pharyngeal suction and some cases tracheostomy.
Sequelae following injury to the head are numerous and included motor and sensory paralyse traumatic.
epilepsy change in personality.
The accessory air sinuses maybe the site of infection collectively termed sinusitis spreading from the nose with which they are intimately connected.

first aid is is urgently needed for head injury

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A Stage of cerebral concusion occur almost immediately and maybe so Transient that it escape notice if seen the patient should be put almost prone (in coma position) with the head lowered as the cough and the swallowing reflex will be absent show that any bleeding from the mouth or regurgitation of food or fluid from stomach aur oesophagus runs out of the mouth and is not inhaled.
if not breathing the Airway should be cleared and if necessary artificial respiration started until medical aid comes.
observe bleeding. Sclap wounds bleed freely and can generally be controlled by a pad firmly bandaged ( using a crepe bandage) over bleeding sites until help comes and the scalp can be sutured. Intracranial hemorrhage maybe extradural and generally necessitates Corporation all the bleeding maybe subdural.
levels of consciousness. A nurse should be familiar with these noting the degree of responsiveness in order to be able to report indication of deterioration aur improvement. She should also be familiar with the observation and care of an unconscious patient.
discharge from ears and nostrils maybe blood but may also be cerebrospinal fluid escaping as the result of fracture of the base of the skull.
the state of the pupils if dilated or unequal the condition of reflex to light the presence of squint give variable information to a surgeon necessary observation include routine estimation of blood pressure temperature pulse and respiration the state of the skin as regards colour warmth sweating restlessness need for restraint of the present possibility of a distended bladder or need to empty the bowel indication of pain aur headache noiseless of the patient alteration and difficulty in a speech and difficulty in swallowing.

head injury

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Head injury occur inform 50 to 80% of all road and transit accidents and no head injury can be lately regarded it is commonest cause of all young mail death the vault or the base of the skull or both maybe fractured.

the formation of the nose

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The bony framework of the nose for the nasal fossae is composed of two cavities about the middle of the face separated from each otherby a thin partition which extends from the palate up to the frontal bone these cavities communicate with the Sinuses of the frontal ethmoid maxillary sphenoid bones infection mein spread from the nasal cavity to these Sinuses.

Mandible

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The Mandible from the lower jaw. It is the only movable bone in the skull apart from the ossicles of the ear. It consists of a body which the central curved horizontal part containing the lower teeth and forming the chin and Two upright portion Rami one at each side which join the body at the angle of the jaw.
The ramus terminates above in two process the coronoid process in front and the condyle off the jaw or as it is sometimes called the head of the mandible which lies behind this mandibular head or condyle articulates with the temporal bone to form the temporomandibular joint.
the mandible may be depressed and alleviated as in opening and closing the mouth it maybe proud retracted and moved slightly from side to side as in mastication.

Bones of the Face

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There are 14 facial bones all expect the mandible being United by sutures and immovable.
Two nasal bones from the bridge of the nose.
Two Palatine Bones from the roof of the mouth and the floor of the nose.
Two lacrimal bones from the tear ducts and part of the orbit at the inner angle of the eye through which is the fluid from the eye is carried to the nasal cavity.
Two Zygonatic bones from the cheek bones. Process from these bones unit with the zygomatic process of the temporal bones to from the zygomatic arch.
One vomer from the lower part of the bony partition in the nose. ( the upper part of the nasal septum is formed by the perpendicular plate of the ethnicity.)
Two inferior turbinate bones are the larger fear of three projections nasal conchae from the lateral wall of the maxilla.
Two maxilla from the upper jaw and content the upper teeth the body of the maxilla contents a large cavity the maxillary sinus, or antrum of Highmore, which communicates with the nasal cavity by to a small openings.

The mandible

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The bones of the face

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Air sinuses of the skull

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Several cavities of Chambers are contained in the bones of the skull the frontal maxillary ethmoid and sphenoid sinuses paranasal sinuses which communicated with the nose air sinuses lighten the weight of the skull and give resonance to the voice.
The frontal sinuses lie in the frontal bone one on is shayari at the route of the nose above the inner angle of the eye the maxillary sinuses sometimes known as antra of highmore lie one inside of the nose in the maxillary bones

Air sinuses

Neonatal skull viewed from above

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Neonatal skull viewed from above

Fontanelles

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The bone of the Skull of an infant at birth not completely ossified the space between the Bona field in bye membrane and at the angles of the bones these membranes are called Fontanelles the largest of these is situated at the junction of the frontal and the to parietal bone where are the coral sagittal structure meet this is called the interior Fontanelles it is Diamond shape major about force from back to font and forms a soft spot on the head of an infant through which the brain can be felt pulsating this Fontanelle normally closed at the age of 18 months.
The posterior Fontanelle lies at the back at the junction of the two who created and the fetal bone close soon after birth

The Sphenoid Bone scene from the front

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The Sphenoid Bone scene from the front

The structure of Cranium

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The bones of the skull are United Together by immovable joints called sutures, with the exception of one of the bone of the face the mandible or lower job which articulates with the temporal at the mandibular joint the principle of structure are the coronal structure between the frontal bone and the two partial bone

The Ethmoid Bone

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The Ethmoid is is a light spongy bone cubicle in a space situated at the roof of the nose wedged in between the orbits it consists off to literal masses Labyrinth compose of the Ethmoid cells or sinuses which are close aspect where the communicate with the nasal cavity Ethmoid content also a perpendicular plate and a cerebriform plate the perpendicular plate from the upper part of the nasal septum the cribriform plate fits into a notch on the frontal bone above this plate the olfactory bulbs Lie and throw the perforation in the plate filaments of the olfactory nerves pass to the upper part of the nose

The left temporal bone seen from the side and below

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The left temporal bone seen from the side and below

The frontal bone seen from below

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The frontal bone seen from below

Temporal bones

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Two temporal bones from the lower part of the sides of the skull each bone consists of a number of parts the squamous part squama projects upwards and gives attachment to the temporalis muscles from the the zygomatic bone behind and below the root of this process lies the external auditory meatus.
the mastiod force and lies behind and it is continued downwards as the mastoid process its outer surface gives attachment to the the astronomers tied muscle the mastoid process continue a space known as the mastoid air cells and a particular Li large space living a little in front of these is named the tympanic antrum this space is end with epithelium which is continuous with that of a middle ear and tympanic cavity infection spreading from the middle ear lead to suppression in the tympanic antrum

Frontal Bones

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The Frontal Bones from the forehead and the upper part of the orbital cavities the super aur supraorbital margin is marked by the supraorbital notch in its inner half through this notch the supraorbital vessels and the supraorbital nerve pass. The inner surface of the frontal bone is marked by depressions which are produced by the convolutions of the brain

Parietal Bones

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The two Parietal bones together from the roof and sides of the skull the outer surface is smooth but the inner surface is marked by Deep furrows which lowers the cranial arteries.
A very large furrow David the middle of the bone lodge the meningeal artery.
Rupture obesity causes places on the software issue with screen damage first on the same side and later on the opposite side as well this result is alteration in the size of the pupils a very important nursing observation during the care of patient with head injury

The Occipital bone viewed from below

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The Occipital bone viewed from below

Occipital

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The Occipital bone is at the back and lower part of the carnial cavity it is pierced by the foraman Magnum through which the medulla oblongata passes to join the spinal cord each side of the foramen Magnum message of born which from the condyles doctor and present articulating for the Atlas

Cranial bones

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Occipital
temporal
Parietal
Sphenoid
Frontal
Ethmoid

The left side of Skull

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The left side of hospital indicating the position of some of the bones and structure and the the temperature mandibular joint

the interior of the cavity of the skull

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showing the anterior middle and posterior cranial Fossae the foraminae and nurse and blood vessels which pass through them