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Head Injury
1. H EAD INJURY AND TRUMATIC BRAIN INJURY Dr.Mansoor Khan MBBS, FCPS-I,Resident SCW, KTH, Peshawar Mar14 th , 2009
2. “ T raumatic Brain Injury is an insult to the brain caused by an external physical force ”
3. N o obvious external signs, resulting from –motor vehicle crashes, falls, child abuse, or domestic violence, child violence.. O bvious external wound For example a gunshot wound or object penetrating the skull. TBI C LOSED HEAD INJURY O PEN HEAD INJURY
4. Highest among adolescents , young adults, and those older than 75 Vehicle crashes are the leading cause of brain injury. Falls are the second leading cause 50% of major trauma deaths are due to TBI
15. When the brain suddenly shifts inside the skull and knocks against the skulls bony surface. Concussions can last from a few moments, to an unconscious state for over 3 minutes. CONCUSSION
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17. POSSIBLE SITE OF BRAIN INJURY FOLLOWING A BLOW TO BACK OF HEAD BRAIN CONTUSIONS Skull Contusion, or bruising of the brain may occur at the site of the blow. Brain Area of bruising Site of impact
18. Conduct Primary Survey If symptoms indicate severe head trauma, call ambulance Monitor casualty’s level of consciousness If casualty falls unconscious and breathing ceases, commence CPR until further help arrives BRAIN CONTUSION
19. EXTR-DURAL HEMATOMA Blow to the temporal, parietal bone Rupture of the middle meningial artey Initial concussion followed by lucid interval Respects the suture lines. Seen on CT Brain as lens- shaped blood collection with a convex medial border . Carries a 5% to 20% mortality rate
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21. Severe head injury-Sudden deceleration injuries Rupture of a bridging vein Thin layer of blood in the subdural space Crescent-shaped blood collections with a concave medial border. This does not resect the suture lines. Note also midline shift. SUB-DURAL HEMATOMA
22. SUB-ARACHNOID HEMORRHAGE Bleeding occurs between the arachnoid and pia mater Increased attenuation is seen in the CSF spaces over the cerebral hemispheres
23. INTRA-CEREBRAL HEMORRHAGE Injury of the brain substance itself Associated with cerebral laceration, contusion, oedema and necrosis Evacuation of the clots can have poor results Not as easy to remedy.
26. Mild Head injury. GCS 13 – 15 80% Moderate Head injury GCS 9 – 12 10% Severe Head injury GCS < 9 10%
27. GCS<13 at any point GCS 13-14 at 2 0 Focal deficit ? Open/depressed/Basal # Post-traumatic seizure > 1 vomiting episode LoC or ante grade amnesia No imaging now CT within 1hr + Get help! - When to do CT- Scan Age 65 Coagulopathy/warfarin + + Dangerous Mex: pedestrian rta, ejection, fall > 1m / 5stairs. Retrograde amnesia>30mins - - - CT within 8hrs +
28. Deep cuts or tears to the scalp Nausea Vomiting Severe headache Visual disturbance Drowsiness or difficulty being aroused Unequal sized pupils, or pupils that do not respond to light Paralysis, numbness or loss of function over one half of the body Problems with balance Fluid flowing from eyes and/or mouth Drunken behaviour Fits, confusion or unconsciousness PRESENTATION
29. Intense headache, worse when lying flat and/or with physical exertion Unequal or dilated pupils Vomiting Weakness on one side of the body Noisy, irregular breathing Irritable or aggressive behaviour INCREASED ICP
30. Sedate and intubate Nurse patient at 30 degree angle-aids venous drainage Mild hyperventilation- keep pCO2 approx 4.5kPa- if allowed to fall lower this leads to vasoconstriction and subsequent ischaemia Mild hypothermia INCREASED ICP
31. INCREASED ICP Surgical management Burr holes Evacuation of mass lesion +/- craniectomy Decompressive craniectomy
