Head injury is a leading cause of death

1. Head InjuryHead Injury

2. Definition of head injury
Discus the types of head injury
Understand the different sign and symptom of head
injury
Describe the pathophysiol0gy of head injury
Explain the diagnostic evaluation of head injury
Enlist the complication of head injury
Detail the management of head injury

3. Any trauma to the scalp, skull, or brain
Head trauma includes an alteration in
consciousness no matter how brief

4. Causes
Motor vehicle accidents
Firearm-related injuries
Falls
Assaults
Sports-related injuries
Recreational accidents

5. High potential for poor outcome
Deaths occur at three points in time after
injury:
Immediately after the injury
Within 2 hours after injury
3 weeks after injury

6. Scalp lacerations
The most minor type of head
trauma
Scalp is highly vascular → profuse
bleeding
Major complication is infection

7. Types of Head Injuries
Skull fractures
Linear or depressed
Simple, comminuted, or compound
Closed or open
Direct & Indirect
Coup & Contrecoup

8. Skull fractures
Location of fracture alters the
presentation of the manifestations
Facial paralysis
Conjugate deviation of gaze palsy
Battle’s sign

9. Basal Skull fractures
CSF leak (extravasation) into ear (Otorrhea) or
nose (Rhinorrhea)
High risk infection or meningitis
“HALO Sign (Battle Sign)” on clothes of linen
Possible injury to Internal carotid artery
Permanent CSF leaks possible

10. Fig. 55-13

11. Minor head trauma
Concussion
A sudden transient mechanical head
injury with disruption of neural
activity and a change in LOC
Brief disruption in LOC
Amnesia
Headache
Short duration

12. Minor head trauma
Postconcussion syndrome
2 weeks to 2 months
Persistent headache
Lethargy
Personality and behavior
changes

13. Major head trauma
Includes cerebral contusions and
lacerations
Both injuries represent severe
trauma to the brain

14. Major head trauma
Contusion
The bruising of brain tissue within a
focal area that maintains the integrity
of the pia mater and arachnoid layers
Lacerations
Involve actual tearing of the brain
tissue
Intracerebral hemorrhage is generally
associated with cerebral laceration

15. Diffuse axonal injury (DAI)
Widespread axonal damage
occurring after a mild, moderate, or
severe TBI
Process takes approximately 12-24
hours

16. Diffuse axonal injury (DAI)
Clinical signs:
↓ LOC
↑ ICP
Decerebration or decortication
Global cerebral edema

17. Epidural hematoma
Results from bleeding between the
dura and the inner surface of the
skull
A neurologic emergency
Venous or arterial origin

18. Subdural hematoma
Occurs from bleeding between the
dura mater and arachnoid layer of
the meningeal covering of the brain

19. Fig. 55-15
Subdural Hematoma
Epidural Hematoma

20. Subdural hematoma
Usually venous in origin
Much slower to develop into a mass
large enough to produce symptoms
May be caused by an arterial
hemorrhage

21. Subdural hematoma
Acute subdural hematoma
High mortality
Signs within 48 hours of the injury
Associated with major trauma
(Shearing Forces)
Patient appears drowsy and confused
Pupils dilate and become fixed

22. Subdural hematoma
Subacute subdural hematoma
Occurs within 2-14 days of the
injury
Failure to regain consciousness
may be an indicator

23. Subdural hematoma
Chronic subdural hematoma
Develops over weeks or months
after a seemingly minor head
injury

24. CT scan considered the best diagnostic test
to determine craniocerebral trauma
MRI
Cervical spine x-ray
Glasgow Coma Scale (GCS)
Craniotomy
Craniectomy
Cranioplasty
Burr-hole

25. Nursing Assessment
GCS score
Neurologic status
Presence of CSF leak

26. Nursing Diagnoses
Ineffective tissue perfusion
Hyperthermia
Acute pain
Anxiety
Impaired physical mobility

27. Planning
Overall goals:
Maintain adequate cerebral
perfusion
Remain normothermic
Be free from pain, discomfort, and
infection
Attain maximal cognitive, motor,
and sensory function

28. Nursing implementation
Health Promotion
Prevent car and motorcycle
accidents
Wear safety helmets

29. Acute Intervention
Maintain cerebral perfusion and
prevent secondary cerebral ischemia
Monitor for changes in neurologic
status

30. Ambulatory and Home Care
Nutrition
Bowel and bladder management
Spasticity
Dysphagia
Seizure disorders
Family participation and education

31. Expected Outcomes
Maintain normal cerebral perfusion
pressure
Achieve maximal cognitive, motor,
and sensory function
Experience no infection,
hyperthermia, or pain

32.  McCaffrey RJ (1997). "Special Issues in the Evaluation of Mild
Traumatic Brain Injury". The Practice of Forensic
Neuropsychology: Meeting Challenges in the Courtroom. New
York: Plenum Press. pp. 71–75. ISBN 0-306-45256-1.
Jump up^ "What is Head Trauma?". News Medical.
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^ Jump up to:a
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Jump up^ "Head Injury (Brain Injury)". eMedicinehealth.
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Jump up^ name="Head Injury (Brain Injury)"
Jump up^ Carlson, Neil R. (2013). "Physiology of Behavior". In
Campanella, Craig.Neurological Disorders. Pearson Education,
Inc. pp. 526–527. ISBN 0-205-23939-0.