A head injury can cause damage to the scalp, skull or brain from trauma. The main types of head injuries are lacerations, concussions, contusions, hemorrhages, compressions, and skull fractures. Symptoms vary depending on the type of injury but may include headaches, nausea, blurred vision, confusion and loss of consciousness. Treatment focuses on monitoring the person's condition, controlling bleeding if present, preventing further injury, and seeking immediate medical help for serious injuries or worsening symptoms.

1. HEAD INJURYHEAD INJURY
RUDANI KRUPALI J.RUDANI KRUPALI J.
F .Y. M.Sc. Nursing student,F .Y. M.Sc. Nursing student,
I.K.D.R.C.I.K.D.R.C.
College of Nursing,College of Nursing,
AhmedabadAhmedabad

2. ANATOMY OF HEAD:

4. Head InjuryHead Injury
A head injury is any trauma resulting inA head injury is any trauma resulting in
injury to the scalp, skull or brain.injury to the scalp, skull or brain.
A head injury is particularly dangerous as,A head injury is particularly dangerous as,
at first the injury may appear only minorat first the injury may appear only minor
however major internal injuries havehowever major internal injuries have
occurred.occurred.
A victim with a suspected head injuryA victim with a suspected head injury
should be monitored for a number of daysshould be monitored for a number of days
after the incident.after the incident.

5. Head Injury
• Causes
– Motor vehicle accidents
– Firearm-related injuries
– Falls
– Assaults
– Sports-related injuries
– Recreational accidents

6. There are five main types of
head injuries:
Lacerations
Concussion
Contusions
Haemorrhage
Compression
Skull Fracture

7. What are LacerationsWhat are Lacerations
• A laceration is a tear in theA laceration is a tear in the
skin as a result of an injury.skin as a result of an injury.
In the case of visible bonesIn the case of visible bones
or tendons, or excessiveor tendons, or excessive
bleeding or pain, the casualty should bebleeding or pain, the casualty should be
seen to by a doctorseen to by a doctor

8. Symptoms of LacerationsSymptoms of Lacerations
• BleedingBleeding
• PainPain
• NumbnessNumbness
• Swelling ofSwelling of
Injured SkinInjured Skin

9. Treating LacerationsTreating Lacerations
• Conduct Primary SurveyConduct Primary Survey
• If symptoms appear serious, anIf symptoms appear serious, an
ambulance should be called immediatelyambulance should be called immediately
• Place a dry, sterile dressing onto woundPlace a dry, sterile dressing onto wound
and apply direct pressure. If skull fractureand apply direct pressure. If skull fracture
is suspected, minimise pressure.is suspected, minimise pressure.
• Use a roller gauze to secureUse a roller gauze to secure
dressings to the head.dressings to the head.
Do not remove dressingsDo not remove dressings

10. What is a concussion?What is a concussion?
• A concussion is a temporary change inA concussion is a temporary change in
the way the brain works when it isthe way the brain works when it is
suddenly moved or jarred,suddenly moved or jarred,
it occurs when theit occurs when the
brain suddenly shiftsbrain suddenly shifts
inside the skull andinside the skull and
knocks against theknocks against the
skulls bony surface.skulls bony surface.
• Concussions can last from a fewConcussions can last from a few
moments, to an unconscious state formoments, to an unconscious state for
over 3 minutes.over 3 minutes.

11. Symptoms of a ConcussionSymptoms of a Concussion
• Amnesia, short term memory lossAmnesia, short term memory loss
• Nausea, vomitingNausea, vomiting
• HeadacheHeadache
• Blurred VisionBlurred Vision
• ConfusionConfusion
• Ringing in EarsRinging in Ears
• Neck PainNeck Pain
• DizzinessDizziness
• UnconsciousnessUnconsciousness
• IrritabilityIrritability
• ConvulsionsConvulsions

12. Treating a ConcussionTreating a Concussion
• Conduct Primary Survey Determine the severity orConduct Primary Survey Determine the severity or
‘grade’ of the concussion.‘grade’ of the concussion.
– Grade 1 – conscious, symptoms last under 15Grade 1 – conscious, symptoms last under 15
minutesminutes
– Grade 2 – conscious, symptoms last over 15 minutesGrade 2 – conscious, symptoms last over 15 minutes
– Grade 3 - unconsciousGrade 3 - unconscious

13. Grade 1Grade 1 Grade 2Grade 2 Grade 3Grade 3
Allow casualty toAllow casualty to
rest, howeverrest, however
continuallycontinually
monitor in casemonitor in case
their conditiontheir condition
changes. Laychanges. Lay
casualty downcasualty down
with their headwith their head
and shouldersand shoulders
slightly raisedslightly raised
Seek professionalSeek professional
medicalmedical
assistance, layassistance, lay
the casualty downthe casualty down
with the head andwith the head and
shoulders slightlyshoulders slightly
raised. Try toraised. Try to
keep casualtykeep casualty
awake and talkingawake and talking
Call anCall an
ambulanceambulance
immediately, layimmediately, lay
casualty downcasualty down
with head andwith head and
shoulders slightlyshoulders slightly
raised, try toraised, try to
keep them awakekeep them awake
and talking. Ifand talking. If
casualty fallscasualty falls
unconscious andunconscious and
is not breathing,is not breathing,

14. What is a Cerebral ContusionWhat is a Cerebral Contusion
• A contusion is a bruise to the brain tissueA contusion is a bruise to the brain tissue
which occurs when a number of small bloodwhich occurs when a number of small blood
vessels leak intovessels leak into
brain tissue.brain tissue.
• Contusions occurContusions occur
when the brainwhen the brain
strikes a ridge instrikes a ridge in
the skull, when thethe skull, when the
head moveshead moves
suddenly or hits a solid object with greatsuddenly or hits a solid object with great
force.force.

15. Symptoms of a ContusionSymptoms of a Contusion
• Severe HeadacheSevere Headache
• DizzinessDizziness
• Nausea / VomitingNausea / Vomiting
• Dilated PupilDilated Pupil
• Weakness of limbsWeakness of limbs
• Restless, irritableRestless, irritable
• Memory LossMemory Loss
• ConfusionConfusion
• DrowsinessDrowsiness
• UnconsciousnessUnconsciousness

16. Treating a ContusionTreating a Contusion
• Conduct Primary SurveyConduct Primary Survey
• Seek medical assistance, if symptoms indicateSeek medical assistance, if symptoms indicate
severe head trauma, call ambulance immediatelysevere head trauma, call ambulance immediately
• Monitor casualty’s level ofMonitor casualty’s level of
consciousnessconsciousness
• Encourage the casualty toEncourage the casualty to
stay awake and talk,stay awake and talk,
reassure themreassure them
• If casualty falls unconsciousIf casualty falls unconscious
and breathing ceases, commenceand breathing ceases, commence
CPR until further help arrivesCPR until further help arrives Bilateral Cerebral
Contusions

17. What is a HaemorrhageWhat is a Haemorrhage
A brain or subarachnoidA brain or subarachnoid
haemorrhage occurshaemorrhage occurs
when blood leaks out ofwhen blood leaks out of
the blood vessels andthe blood vessels and
onto the surface of theonto the surface of the
brain. The blood thenbrain. The blood then
damages the brain tissuedamages the brain tissue
which, along with thewhich, along with the
blood loss, can causeblood loss, can cause
serious and potentiallyserious and potentially
life threatening brainlife threatening brain
damagedamage

18. Haematomas are collections ofHaematomas are collections of
blood in the brain that may beblood in the brain that may be
epidural (above the dura),epidural (above the dura),
subdural (below the dura), orsubdural (below the dura), or
intracerebral (within the brain).intracerebral (within the brain).

20. Epidural and Subdural HematomasEpidural and Subdural Hematomas
Fig. 55-15
Epidural Hematoma
Subdural Hematoma

21. Symptoms of a HaemorrhageSymptoms of a Haemorrhage
• Sudden and Severe headacheSudden and Severe headache
• Nausea / vomitingNausea / vomiting
• UnconsciousnessUnconsciousness
• SeizureSeizure
• ParalysisParalysis
Preserved brain with haemorrhage

23. Treating a HaemorrhageTreating a Haemorrhage
• Conduct primary surveyConduct primary survey
• Call an ambulance immediatelyCall an ambulance immediately
• Monitor level of consciousnessMonitor level of consciousness
• If casualty falls unconscious, commenceIf casualty falls unconscious, commence
CPR and continue until further help arrivesCPR and continue until further help arrives
• If casualty has a seizure, clear them ofIf casualty has a seizure, clear them of
any dangers and position them on theany dangers and position them on the
ground in a comfortable position and waitground in a comfortable position and wait
for seizure to end. Once ended, rollfor seizure to end. Once ended, roll
casualty into recovery positioncasualty into recovery position
• Monitor Vital signs until ambulance arrivesMonitor Vital signs until ambulance arrives

24. What is a CerebralWhat is a Cerebral
CompressionCompression
• A cerebralA cerebral
compression involvescompression involves
a build up of pressurea build up of pressure
on the brain and canon the brain and can
be life threatening,be life threatening,
most often requiringmost often requiring
surgery. Cerebralsurgery. Cerebral
compression occurscompression occurs
when there is anwhen there is an
accumulation of bloodaccumulation of blood
within the skull orwithin the skull or
injured brain tissueinjured brain tissue
swellsswells

25. Symptoms of a cerebral compressionSymptoms of a cerebral compression
• Recent head injuryRecent head injury
• HeadacheHeadache
• Noisy, slow breathingNoisy, slow breathing
• Slow pulseSlow pulse
• Unequal pupil sizeUnequal pupil size
• Weakness ofWeakness of
paralysis down oneparalysis down one
side of bodyside of body
• High temperatureHigh temperature
• DrowsinessDrowsiness
• Change in behaviourChange in behaviour
• DisorientationDisorientation

26. Treating a cerebral compressionTreating a cerebral compression
• Conduct Primary SurveyConduct Primary Survey
• Call for an ambulanceCall for an ambulance
• If conscious, rest casualty in comfortableIf conscious, rest casualty in comfortable
position, reassure them and monitor vitalposition, reassure them and monitor vital
signs until help arrivessigns until help arrives
• If unconscious and not breathing,If unconscious and not breathing,
commence CPR and continue until helpcommence CPR and continue until help
arrives. If breathing, ensure airway isarrives. If breathing, ensure airway is
open.open.

27. What is a Skull FractureWhat is a Skull Fracture
• A skull fractureA skull fracture
occurs after a headoccurs after a head
injury and can beinjury and can be
life threatening aslife threatening as
the fractured bonethe fractured bone
may causemay cause
damage to thedamage to the
brain.brain.

29. TYPE OF SKULL FRACTURETYPE OF SKULL FRACTURE
•Linear or depressedLinear or depressed
•Simple, comminuted, orSimple, comminuted, or
compoundcompound
•Closed or openClosed or open
•Direct & IndirectDirect & Indirect

30. Symptoms of a Skull FractureSymptoms of a Skull Fracture
• Wound of Bruise on headWound of Bruise on head
• Depression on scalpDepression on scalp
• Altered level ofAltered level of
responseresponse
• Distortion of faceDistortion of face
• Blood in the eyeBlood in the eye
• Clear fluid dischargeClear fluid discharge
from nose or earfrom nose or ear
• Bruising around eyesBruising around eyes
• Bruising or swelling behind an earBruising or swelling behind an ear

32. Treating a Skull FractureTreating a Skull Fracture
• Conduct Primary SurveyConduct Primary Survey
• If conscious, allow casualtyIf conscious, allow casualty
to lie down, stabilize headto lie down, stabilize head
and neck, control anyand neck, control any
bleeding by applying dressingbleeding by applying dressing
with pressure, in case ofwith pressure, in case of
discharge cover ear but do notdischarge cover ear but do not
plug, monitor vital signsplug, monitor vital signs
• If unconscious and not breathing, commenceIf unconscious and not breathing, commence
CPR and continue until further help arrives. IfCPR and continue until further help arrives. If
breathing ensure airway remains open.breathing ensure airway remains open.

33. Head Injury
Diagnostic Studies and
Collaborative Care
• CT scan considered the best diagnosticCT scan considered the best diagnostic
test to determine craniocerebral traumatest to determine craniocerebral trauma
• MRIMRI
• Cervical spine x-rayCervical spine x-ray
• Glasgow Coma Scale (GCS)Glasgow Coma Scale (GCS)
• CraniotomyCraniotomy
• CranioplastyCranioplasty
• Burr-holeBurr-hole

34. CT sCan

35. MRIMRI

36. COMPLICATIONS:
Coma
Chronic headaches
Loss of or change in sensation, hearing,
vision, taste, or smell
Paralysis
Seizures
Speech and language problems
Death

37. • MEDICAL MANAGEMENTMEDICAL MANAGEMENT
• This is an extreme emergency becauseThis is an extreme emergency because
marked neurologic deficit or respiratory arrestmarked neurologic deficit or respiratory arrest
may occur within minutes.may occur within minutes.
• Burrholes are made to remove the clots, andBurrholes are made to remove the clots, and
the bleeding point is controlled (craniotomy,the bleeding point is controlled (craniotomy,
drain insertion).drain insertion).
• Management involves control of ICP,Management involves control of ICP,
supportive care (ventilatory support, seizuresupportive care (ventilatory support, seizure
prevention, fluid and electrolyte maintenance,prevention, fluid and electrolyte maintenance,
nutritional support, and pain).nutritional support, and pain).
• Elevation of the head of the bed.Elevation of the head of the bed.

38. NURSINGNURSING
MANAGEMENTMANAGEMENT
Nursing AssessmentNursing Assessment
–GCS scoreGCS score
–Neurologic statusNeurologic status
–Presence of CSF leakPresence of CSF leak

40. InITIal ManageMenTInITIal ManageMenT
•A: Airway control includingA: Airway control including
cervical spine immobilisationcervical spine immobilisation
with a stiff collar.with a stiff collar.
•B: BreathingB: Breathing
•C: CirculationC: Circulation
•D: Dysfunction or DisabilityD: Dysfunction or Disability
•E: External ExaminationE: External Examination

41. NURSING DIAGNOSISNURSING DIAGNOSIS: -: -
Ineffective airway clearance and impaired gasIneffective airway clearance and impaired gas
exchange related to brain injury.exchange related to brain injury.
Ineffective Cerebral tissue perfusion related toIneffective Cerebral tissue perfusion related to
increased ICP and decreased cerebral perfusionincreased ICP and decreased cerebral perfusion
pressure (CPP).pressure (CPP).
Fluid volume deficit related to decrease LOCFluid volume deficit related to decrease LOC
and hormonal dysfunction.and hormonal dysfunction.
Imbalanced nutrition, less than bodyImbalanced nutrition, less than body
requirement, related to increased metabolicrequirement, related to increased metabolic
demand and inadequate intake.demand and inadequate intake.

42. Risk for injury related to decreased level of
consciousness.
Ineffective thermoregulation related to damage
to hypothalamic centres.
Risk for Impaired skin integrity related to
compromised circulation shifting of fluid from
intra vascular to interstitial space.
Anxiety related to outcome of diseases as
evidenced by poor concentration on work,
isolation from others, rude behaviour.
Disturbed sleep pattern related to brain injury
and frequent neurologic checks.
Knowledge deficit regarding the treatment

43. THANK YOU!!!!!
THANK
YOU!!!!!