This presentation gives a complete brief about head injury.This is going to deal with the definition,causes, clinical manifestations,types and complete management of head injury with its emergency management.

1. HEAD INJURY
Ms. Shivnetri Chauhan
Nursing tutor
Faculty of nursing,Rama university

2. DEFINITION
It includes heavy trauma to scalp,skull or brain.
TYPES
1. Scalp laceration
They are easily recognised type of external head trauma because the scalp containing
many blood vessels with poor constriction ability.
2. Skull
a. Linear fracture
Brain in the continuity of bone without alteration in parts.
b. Depressed fracture
Invert intendation of skull.
C. Simple fracture
Linear or depressed skull fracture wi9thout fragments.
d.Communited fracture
Multiple linear fracture with fragmentation of bone into many pieces.

3. e. Compound fracture
Depressed skull fracture and scalp lacerations with communicating pathway to intracranial
cavity.
CLINICAL MANIFESTATIONS
FRONTAL BONE FRACTURE
•Exposure of brain contents through air sinuses.
•CSF rhinorrhea.
•Pneumocranium.
ORBITAL FRACTURE
•Periorbital ecchymosis.
•Optic nerve injury.
TEMPORAL FRACTURE
•Battle sign(Oval shaped greuys behind ear in the mastoid region).
PARIETAL FRACTURE
•Deafness
•CSF otorrhea
•Bulging of tympanic membrane caused by blood or CSF.
•Loss of taste.

4. OCCIPETAL FRACTURE
•Occipetal bruising resulting in cortical blindness.
•Visual field defects.
BASILLAR SKULL FRACTURE
•CSF or brain otorrhea.
•Bulging of tympanic membrane.
•Battle sign.
•Facial paralysis
•Vertigo.
CLASSIFICATION OF HEAD INJURY
1. Minor head trauma or injury(CONTUSSION)
A sudden transient ,mechanical head injury with disruption of neural activity and changes in
the level of consciousness.
2. Major head trauma
It includes cerebral contussions and lacerations which represents severe trauma to the brain
tissues.

5. COMPLICATIONS
•Bleeding
•Epidural hematoma: It results from bleeding between the dura and inner surface of the
skull.It may be venous or arterial in origin.
•Subdural hematoma: It occurs from bleeding between dura layer and arachnoid layer of
meninges. It usually results from injury to the brain substances and its parenchymal tissues.
•Intracerebral hematoma: It occurs from bleeding within the parenchyma and occurs in
approximately 16% of head injuries.It usually occurs in frontal and temporal lobes.
DIAGNOSTIC EVALUATION
•CT
•MRI
•PET

6. SURGICAL MANAGEMNT
1. Burr hole
It is an opening to the cranium with a drill used to remove localised fluid and blood
beneath the dura.
2. Craniotomy
Opening into the cranium by removing the bone flap and opening the dura to remove the
lesion repair and damage area to drain blood and relief in increased ICP.
3.Craniectomy
Excision into the cranium to cut away the bone flap.
4.Cranioplasty
Repair of the cranial defect resulting from trauma malformations or previous surgical
procedure. Artificial material is used to replace the damaged or lost bone.
5.Shunt procedures
Alternative pathways to redirect the CSF from one area to another by using a tube or
implanted device.

7. EMERGENCY MANAGEMENT
•Ensure patent airway.
•Stabilise cervical spine.
•Administer oxygen.
•Establish IV line with large bore catheter.
•Control external bleeding with sterile pressure dressing.
•Assess for rhinnorrhea, otorrhea.
•Maintain patient warmth using blankets or overhead lights.
•Monitor vitals, level of consciousness, oxygen saturation , GCS and pupil size.
•If CSF rhinorrheaa or otorrhea occurs the inform the doctor , raise the bed to decrease the
CSF pressure.
•No dressing should be placed.
•Collection of pads under area.
•Caution the patient not to sneeze or blow the nose.
•NG tube should not be used due to the risk of meningitis.