Head Injury


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Head Injury

  1. 1. H EAD INJURY AND TRUMATIC BRAIN INJURY Dr.Mansoor Khan MBBS, FCPS-I,Resident SCW, KTH, Peshawar Mar14 th , 2009
  2. 2. “ T raumatic Brain Injury is an insult to the brain caused by an external physical force ”
  3. 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. 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
  5. 5. Motor Vehicle Crashes Crashes- 44% Falls - 26% Other/Unknown - 13% Non-Firearm Assaults Assaults- 9% Firearms Firearms- 8%
  6. 6. These days there is a new category of Head injury –– BLAST INJURY!
  7. 7. How grave are the conditions!!!!!!!!
  8. 8. The Annual cost of TBI to the U.S. is equal to one of these $60.0 Billion!!
  9. 12. M E N I N G E S
  11. 14. LACERATIONS Secure ABC Expose, clean, apply pressure dressing if bleeding
  12. 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
  13. 16. <ul><ul><li>Grade 1 – conscious, symptoms last under 15 minutes </li></ul></ul><ul><ul><li>Grade 2 – conscious, symptoms last over 15 minutes </li></ul></ul><ul><ul><li>Grade 3 - unconscious </li></ul></ul>CONCUSSION Call an ambulance immediately, lay casualty down with head and shoulders slightly raised, try to keep them awake and talking. If casualty falls unconscious and is not breathing, commence CPR and monitor vital signs Seek professional medical assistance, lay the casualty down with the head and shoulders slightly raised. Try to keep casualty awake and talking Allow casualty to rest, however continually monitor in case their condition changes. Lay casualty down with their head and shoulders slightly raised Grade 3 Grade 2 Grade 1
  14. 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
  15. 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
  16. 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
  17. 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
  18. 22. SUB-ARACHNOID HEMORRHAGE Bleeding occurs between the arachnoid and pia mater Increased attenuation is seen in the CSF spaces over the cerebral hemispheres
  19. 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.
  20. 24. DIFFUSE AXONAL INJURY <ul><li>Occurs due to shearing forces between grey and white matter. </li></ul><ul><li>Generalized cerebral oedema results due to parenchymal disruption leadsing to an increase in ICP </li></ul><ul><li>Ranges from mild form-concussion </li></ul><ul><ul><li>severe form- persistent vegetative state </li></ul></ul>
  21. 25. Glasgow coma scale Fully conscious (GCS 15) Confused (GCS 9-14) Comatose (GCS 3-8)
  22. 26. Mild Head injury. GCS 13 – 15 80% Moderate Head injury GCS 9 – 12 10% Severe Head injury GCS < 9 10%
  23. 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 +
  24. 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
  25. 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
  26. 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
  27. 31. INCREASED ICP Surgical management Burr holes Evacuation of mass lesion +/- craniectomy Decompressive craniectomy
  28. 33. THANKS