about head injury

1. Head Injury
Amjad Arida and Zahraa Mustafa

2. Traumatic brain injuries
• Priority assessment:
Assess the level of consciousness, eye response, coordination, memory and
attention, body position, headache, Bleeding in the brain, unresponsiveness, otorrhea,
and rhinorrhea for skull fracture.
History and full physical assessment
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3. Traumatic brain injury
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⦁ Diagnostic Evaluation: CT scan with contrast or MRI - Skull and cervical spine X-ray- CBC- coagulation
profile- electrolyte levels- ABGS- Full neurological exam
Intervention:
1. Maintain ICP monitoring, give osmotic diuretic
2. Maintain airway and ventilation and sedate the patient
3. Surgery Craniotomy for evacuation
4. Monitor blood pressure SBP above 90 and vital signs
5. MAP above 80mmhg
6. Neurological exam and GCS
7. Anticonvulsant and anticoagulant if needed
8. Assess for brain herniation
9. Urinary catheter and feeding

4. Ear injury `
⦁ Priority assessment: tinnitus, bleeding, otorrhea, earache, hearing loss,
vertigo, TM perforation.
⦁ Diagnostic test: otoscope or a microscope to examine the ear- MRI for inner ear
or brain injury -Hearing test Rinne and Weber tests
• Intervention :
• 1. removal of foreign bodies
• 2. clean and irrigate the wound
• 3. cartilage must be closed
• 4.Suction blood clots from the eardrums
• 5. ear should be clean and dry
• 6. antibiotic eardrops
Copyright © 2017 Elsevier Inc. All rights reserved.
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5. Eye injury `
⦁ Priority assessment: pain, loss of vision, eye irritation, foreign body
sensation, altered vision, bleeding, periorbital swelling, bruising, corneal abrasion, open
globe injuries, eyelid laceration, traumatic cataracts, retinal detachment, optic nerve injury,
orbital wall fracture (Ptosis,Enophthalmos, Ocular entrapment)
⦁ Diagnostic test: Light perception- head motion- count finger- CT-MRI-cranial
nerve III, IV, VI.
• Intervention:
• Do not force the lids open to examining the eye- Do not put any pressure on an eye that
may be ruptured- Do not apply a patch or bandage to the eye—use a convex plastic or
metal shield- Do not remove impaled foreign bodies- Administer tetanus, anti-emetics,
and intravenous (IV) broad-spectrum antibiotics if a ruptured globe is suspected;
ceftazidime/vancomycin; consider IV clindamycin
An open eye is asurgical emergency! (possible retinaldetachment…)
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