Traumatic Brain Inuries :Introduction Epidemiology Etiology Symptoms Types Scalp Skull Brain Basic Anatomy Primary Secondary Brain Injuries Complication Management Rehabilitation

2. HEAD INJURIES

3. Presented By :
• Ghalib hussain Khan
• bs. PhysiotheraPy
• institute of
PhysiotheraPy
luMhs JaMshoro
sindh
• eMail:
dr.Khan127@GMail.coM
• facebooK:
www.facebooK.coM/Ghalib.

4. OUTLINES:
• Introduction
• Epidemiology
• Etiology
• Symptoms
• Types
• Scalp
• Skull
• Brain
Basic Anatomy
• Primary
• Secondary
• Brain Injuries
• Complication
• Management
• Rehabilitation

5. Introduction
• Injury to the head may damage the scalp, skull or brain.
• The most important consequence of head trauma is traumatic brain
injury.
• Number One Killer in Trauma
• 25% of all trauma deaths
• 50% of all deaths from MVC
• 200,000 people in the world live with the
disability caused by these injuries

6. Epidemiology
• 1.5 million Non-fatal TBI’s
• 370,000 Hospitalizations
• 80,000 cases of neurological sequela
• 52,000 Die from TBI’s
• 4 billion annually for cost of treatment
• Peak incidence:
• Males age 15-24 years
• Causes of TBI
• Young: GSW
• Old: Falls

7. Etiology
• Motor vehicle accidents
• Firearm-related injuries
• Falls
• Sports-related injuries
• Recreational accidents

8. • Missile wounds
• Stab wounds(most common knife injury)
• Occupational accidents (nails, rewdrivers).
• Nails,
• Metal poles
• Ice picks
• Keys, pencils
• Power drills.

9. Symptoms
unconsciousness, either very briefly (concussion) or for a
longer period of time
• difficulty staying awake or still being sleepy several hours
after the injury
• having a seizure or fit (when your body suddenly moves
uncontrollably)
• difficulty speaking, such as slurred speech

10. • vision problems or double vision
• difficulty understanding what people say
• reading or writing problems
• balance problems or difficulty walking.
• loss of power in part of the body, such as
weakness in an arm or leg
• amnesia (memory loss), such as not being
able to remember what happened before
or after the injury

11. • clear fluid leaking from the nose or ears (this could be
cerebrospinal fluid, which normally surrounds the brain)
• a black eye (with no other damage around the eye)
• bleeding from one or both ears
• new deafness (loss of hearing) in one or both ears
• bruising behind one or both ears
• a lasting headache since the injury
• vomiting since the injury
• irritability or unusual behaviour
• visible trauma (damage) to the head, such as an open,
bleeding wound

12. Signs and Symptoms Glasgow Coma Scale

13. Types of Head Injuries
• Scalp lacerations
• The most minor type of head trauma
• Scalp is highly vascular ® profuse
bleeding
• Major complication is infection

14. TTyyppeess
• Skull fractures
• Linear or depressed
• Simple, comminuted, or compound
• Closed or open
• Direct & Indirect
• Coup & Contrecoup

15. Types of Head Injuries
• Skull fractures
• Location of fracture alters the
presentation of the manifestations
• Facial paralysis
• Conjugate deviation of gaze
• Battle’s sign

16. Brain Injuries

17. Basic Anatomy
• Scalp
• Skull
• Meninges
• Dura Mater
• Arachnoid
• Pia Mater
• Brain Tissue
• CSF and Blood

18. Skull

19. Dura-mater

20. Venous
sinuses

21. Arachnoid
mater

22. Pia-mater

23. CSF

24. Grey
matter

25. White
matter

26. Ventricles

27. Brain Injuries
• Primary (Direct) Brain Injuries
• Secondary (Indirect) Injuries

28. Primary Brain Injuries
• It occur at the time of impact
• Direct damage done to brain parenchyma
and associated with vascular injuries
• Mechanical irreversible damage - brain
lacerations, hemorrhages, contusions, and
tissue avulsions,

29. Secondary Brain Injury
• Damage that occurs after the initial insult (ongoing injury
processes)
• Expanding mass lesions, swelling or bleeding quickly
overwhelm buffers
• End result is increased intracranial pressure (ICP) and/or
herniation

30. Secondary Injury Mechanisms
• Elevated ICP and mechanical shifting
leading to herniation
• Hypoxia
• Hypotension and inadequate Cerebral
Blood Flow
• Cellular mechanisms

31. Intracranial Causes
• Herniation: displaced brain parenchyma
• Damage to brain from trauma against the dura itself
as well as producing ischemia as well
• Cerebral Edema: intracellular fluid collection within
neurons and interstitial spaces.
• Intracerebral Hematomas

32. Brain Injuries – Brain Concussion
• Usually caused by blunt injuries.
• Injuries patient shows transient alteration
in neurologic function
• Mild injury usually with no detectable brain
damage.
• May have brief loss of consciousness.
• Headache grogginess and short memory
loss are common.

33. Brain Injuries – Brain Contusion
• A bruised brain or contusion can occur with closed head
injuries.
• Usually caused by blow that causes the brain to hit
inside the skull
• Unconsciousness or decreased level of consciousness
can occur

34. Brain Injuries – A hematoma
• Is a collection of blood within tissue.
• Hematoma inside the cranium is named
according to its location:
• Subdural hematoma: blood collection
between brain and dura
• Epidural hematoma: blood collection
between dura and the skull
• Subarachnoid Hemorrhage:
• Intracerebral hematoma: blood
collection within the brain

35. Epidural Hematomas
• Blood
between
inner table
of the skull
and the
dura
• Lens
shaped
hematomas
that do not
cross
suture lines
on CT

36. Subdural Hematomas
• Blood beneath the dura,
overlying the brain and
arachnoid, resulting from
tears to bridging vessels
• Crescent shaped density that
may run length of skull
• Very common in the elderly

37. Subarachnoid Hemorrhage
• Bleeding beneath the
arachnoid membrane
on the surface of the
brain.

38. Intracranial Hematoma
• Focal areas of
hemorrhage within
the parenchyma

39. Care of Skull Fractures and Brain Injuries
• Take appropriate body substance
isolation precautions.
• Assume spine injury
• Monitor conscious patient for
changes in breathing
• Apply rigid collar, immobilize the
neck and spine
• Administer high concentration
oxygen
• Control bleeding
• Keep patient at rest
• Talk to conscious patient
(emotional support)
• Dress and bandage open
wounds
• Mange the patient for shock
• Be prepared for vomiting
• Transport patient promptly
• Monitor vital signs every five
minutes

40. Complications-Long Term Sequela
• Seizure Disorder
• 2% Early post-traumatic incidence
• Increased to 30% in children, alcoholics and with
intracranial hematoma
• Prophylactic antiepileptics reduce early occurrence

41. Complications-Long Term Sequela
• Concussion
- Brief LOC - Vertigo
- Nausea
- Dizziness - Headache
- Vomiting
- Photophobia (An abnormal or
irrational fear of light)
- Cognitive/Memory dysfunction
• Up to 80% may have symptoms at 3
months
• 15% may have symptoms at 1 year
• 85-90% recover after 1 year

42. Complications-Long Term Sequela
• Infection
• Skull fracture
• CSF leak
• Intubation
• History of Fracture
• ICU
• Treatment
• Prophylactic antibiotics
• Fever
• Signs of meningitis
• 3rd generation cephalosporin
• Vancomycin

43. Management
• Airway
• Suctioning
• Patient positioning
• OPA and NPA use
• Endotracheal intubation
• Orotracheal
• Nasotracheal
• Cricothyrotomy
• Breathing
• Oxygen
• 15 LPM/NRB
• Ventilations
• 12–20/min
• Hyperoxygenate
• ETCO2 maintained at 35–40
mmHg
• Continuous waveform
capnogrpahy
• Circulation
• Hemorrhage Control
• Blood pressure maintenance
• Fluid resuscitation to SBP of
90 mmHg

44. Medications
• Diuretics.
• Anti-seizure drugs.
• Coma-inducing drugs.

45. Surgery
Removing clotted blood (hematomas).
• Repairing skull fractures.
• Opening a window in the skull.

46. Rehabilitation:
• Physiatrist, a doctor trained in physical medicine
and rehabilitation, who oversees the entire
rehabilitation process
• Occupational therapist: helps the person learn,
relearn or improve skills to perform everyday
activities
• Physical therapist: helps with mobility and
relearning movement patterns, balance and
walking
• Speech and language pathologist, who helps the
person improve communication skills and use
assistive communication devices if necessary
• Rehabilitation nurse

47. • Traumatic brain injury nurse specialist,
who helps coordinate care and educates
the family about the injury and recovery
process
• Recreational therapist, who assists with
leisure activities
• Vocational counselor, who assesses the
ability to return to work and appropriate
vocational opportunities, and provides
resources for addressing common
challenges in the workplace