Lecture on head injuries/head trauma.

1. Head Injuries/Head
Trauma

2. Head Injury
◼Broad classification that includes
injury/trauma to the scalp, skull or
brain.
◼Can range from a minor bump on the
skull to serious brain injury
◼Most serious form- TBI

3. SCALP INJURY
◼Generally classified as a minor
injury
◼ The scalp bleeds profusely when
injured.
◼Trauma may result in an abrasion,
contusion, laceration, hematoma
beneath the layers of tissue of the
scalp and avulsion (teared off)

4. A B
C
D
E

5. ◼Scalp wounds
- potential portal of entry of
microorganisms
- Area is irrigated first before the
laceration is sutured.

6. Skull fractures
◼A break in the continuity of the skull
caused by forceful trauma
◼It may occur with or without damage
to the brain

8. Classification
✔Simple- a crack in the skull
✔Comminuted- splintered or multiple
fracture line
✔Depressed- occur when the bones of
the skull are forcefully displaced
downward.
✔Basilar- fracture of the base of the
skull

13. BRAIN INJURY
❑The most important consideration in
any head injury is whether the brain is
injured.

14. Classification
◼Closed (blunt) brain injury
❑Object did not break the skull
❑Does not cause damage to dura
mater/skull
◼Open/penetrating head injury
❑Occurs when the cranium is fractured
&/or the membranes that surround the
brain are breached

16. ◼A coup injury is the result of a sudden,
violent stop that causes the brain to
accelerate forward and hit the side of the
skull. A countercoup injury, on the other
hand, occurs when the brain accelerates
forward, hits the side of the skull, and then
bounces off the other side of the skull. In both
cases, the brain is damaged as it rubs against
the inner ridges of the skull.

19. Types of Head Injuries
◼Concussion- a violent jarring/shocking
injury to the brain
⮚ temporarily affects normal brain
function
⮚ there is a transient period of
unconsciousness
⮚ person may feel dazed & may lose
vision or balance for a while, vomiting,
slurred speech

22. ◼Contusion- a bruise of the
brain
⮚there is some bleeding in the
brain, causing swelling
⮚characterized by extravasation
of blood vessels

25. ◼Laceration- tearing of tissues
◼Diffuse axonal injury
⮚Axons are stretched & damaged
⮚By high-speed transportation
accidents—associated with shaken
baby syndrome
⮚Causes permanent damage to nerves
in the brain

31. Hematoma
◼Bleeding in the brain that collects & clots,
forming a bump
◼In general, a rapidly developing
hematoma even if small, may be fatal,
whereas a larger but slowly developing
one may allow compensation for
increases in ICP.

32. Classification
◼Epidural
✔between the skull & the dura mater
✔an extreme emergency
✔results from a skull fracture that causes a
rupture or laceration of the middle
meningeal artery
✔Characterized by brief loss of
consciousness
✔ IICP, herniation

34. ◼Subdural
✔between the dura & the brain
(arachnoid)
✔usually due to trauma & ruptured
veins
✔symptoms of IICP develops gradually
◼Intracerebral
✓bleeding into the substance of the
brain

36. Causes
◼Common causes
1. Falls
2. Motor vehicle crashes
3. Being struck by objects
4. Physical assaults
5. Accidents at work, home & outdoors
6. While playing sports
◼Highest risk of TBI: 15 to 19 age group
Males

38. Damage to the brain from
traumatic injury takes 2 forms:
◼Primary injury- initial damage to the
brain that results from the traumatic
event
✔includes contusions, lacerations, &
torn blood vessels

39. ◼Secondary injury- evolves over the
ensuing hours & days after the
initial injury
◼results from inadequate delivery
of nutrients & oxygen to the cells

40. Pathophysiology
Brain suffers traumatic injury
↓
Brain swelling/bleeding inc. intracranial volume
↓
Rigid cranium allows no room for expansion
↓
Slow blood flow to brain due to inc. pressure
↓
Cerebral hypoxia & ischemia occur
↓
Intracranial pressure continues to rise.
Brain may herniate
↓
Cerebral blood flow ceases

41. Clinical Manifestations
◼In any serious head trauma, always
assume the spinal cord is also injured.
◼Chronic or severe headaches
◼Nausea & vomiting
◼Signs & symptoms of IICP
◼Hemorrhage/fluid draining from the
nose, pharynx, ears, conjunctiva

43. ◼Weakness & paralysis
◼Decreasing LOC
◼Decreased sensation, visual
disturbances, seizure
◼Memory loss, personality & behavior
changes
◼Battle’s sign
◼CSF otorrhea, CSF rhinorrhea

46. Assessment & Diagnostic tests
◼Neurologic history
◼X-ray
◼CT scan
◼MRI
◼Cerebral angiography

48. Management
◼Close observation of the patient
◼Monitor LOC, respiratory status &
maintain patent airway
◼Notify the physician if drainage from
the ears or nose is noted.

49. ◼Maintain head elevation
◼Assess cranial nerve function
◼Monitor for IICP
◼Do not take aspirin, ibuprofen, anti-
inflammatory medications
◼Diuretics,
◼anti-seizure medications
▪ Ex, Dilantin, Phenytoin

50. ◼Surgery
✔Needed to lessen intracranial
pressure & brain swelling
✔Remove fractured pieces of skull
✔Insert synthetic implants to protect
brain tissue.

51. The best approach to head injury is
PREVENTION
◼Always use safety equipment during
activities that could result in head injury.
◼Obey traffic signals when riding a bicycle.
◼Be visible
◼Use age-appropriate car seats or boosters
for babies & young children.
◼Make sure that children have a safe area in
which to play.
◼Do not drink & drive

53. First Aid
◼For mild head injury:
⮚ No specific treatment is needed.
⮚ Close monitoring is needed.
⮚ When person is sleeping, wake him/her
q 2 to 3 hours & ask simple questions.

54. ◼For moderate to severe head injury:
⮚Treat as if there is spinal injury
⮚Stop any bleeding by firmly pressing a
clean cloth on the wound.
⮚If with skull fracture do not apply
pressure
⮚If the person vomits, roll the head,
neck & body as one unit to prevent
choking.
⮚Apply ice packs to swollen areas.

56. END.