TREATING INJURY

1. Treat a Casualty
with a Closed Head Injury

2. Combat Trauma 2Head Injury
Introduction
• Most common for individuals working in
hazardous environments
• Delicate structures demand diligence in the care of
injured and damaged sensory organs
• Underlying structures may also be damaged
– Cranium
– Brain
– Trachea
– Neck vessels
– Cervical spine

3. Combat Trauma 3Head Injury
Anatomy and Physiology
of the Head
• Scalp
• Skull (cranium)
• Brain

4. Combat Trauma 4Head Injury
Anatomy and Physiology of
the Head

5. Combat Trauma 5Head Injury
Initial Assessment
• General Impression
• Assess Airway
• Assess Breathing
• Assess circulation

6. Combat Trauma 6Head Injury
Rapid Trauma Assessment
• Look for obvious deformities
– Depressed Skull Fractures
– Lacerations
– All head injuries must be treated as if cervical spine
involvement
• Bleeding from ears and nose
– Clear fluid from ears and nose
– Swelling/discoloration behind ears
– Swelling/discoloration around both eyes
• Assess pupils

7. Combat Trauma 7Head Injury
Open Head Wound

8. Combat Trauma 8Head Injury
Can the patient feel you
touching his fingers and toes?

9. Combat Trauma 9Head Injury
Neurological Exam
• Assess Neurologic status using the Glascow
Coma Scale (GCS)
– Severe head injury: GCS is < 9
– Moderate head injury: GCS is 9 to 12
– Minor head injury: GCS is 13 to 15

10. Combat Trauma 10Head Injury
Glasgow Coma Scale
EYE OPENING
Spontaneous Opening 4
Opens in Response to Speech Command 3
Opens in Response to Pain 2
NIL (No Response) 1
MOTOR RESPONSE (M)
Obeys Request to Move Some Part 6
Localizes (Moves Hand to Touched Place) 5
Withdraws Part From Painful Touch 4
Abnormal Flexion (Elbows, Wrists Bent) 3
Extensor Response (Arms, Legs Straight) 2
NIL (No Response) 1

11. Combat Trauma 11Head Injury
Glasgow Coma Scale
VERBAL RESPONSE (V)
Oriented (Answers Time, Place, Person) 5
Confused Conversation (MayBe Disoriented) 4
Inappropriate Words ("Mother," "Yesterday") 3
Incomprehensible Sounds (Groan, Moan, Scream) 2
NIL (No Vocal Response or Sounds) 1

12. Combat Trauma 12Head Injury
Nasal Injuries
• Signs and symptoms
• Special considerations
• Abrasions, lacerations, and punctures
• Avulsion
• Fully avulsed flaps of skin
• Septum Devaited

13. Combat Trauma 13Head Injury
Nasal Injuries

14. Combat Trauma 14Head Injury
Nasal Injuries
• Foreign objects
• Fully immobilize the spine
• Monitor vital signs, airway, and LOC
• Transport in a sitting position

15. Combat Trauma 15Head Injury
Nasal Injuries
• Nosebleeds (epistaxis)
– No signs or symptoms of skull fracture or spinal injury
– Conscious patient, place in a slightly forward, seated
position to allow for drainage.
– Unconscious patient or if signs and symptoms of spinal
injury are present, place on long spine board in
recovery position.

16. Combat Trauma 16Head Injury
Nasal Injuries

17. Combat Trauma 17Head Injury
Oral Cavity Injuries
• Signs and symptoms
– Lacerated lip or gum
– Lacerated or avulsed tongue
– Dislodged teeth

18. Combat Trauma 18Head Injury
Airway Obstruction

19. Combat Trauma 19Head Injury
Lacerated or Avulsed Tongue

20. Combat Trauma 20Head Injury
Head Injuries
• Scalp wounds
• Skull injuries
– Linear nondisplaced fractures, compound fractures, or
depressed fractures
– Large contusion or darkened swelling of scalp
– Brain Injury

21. Combat Trauma 21Head Injury
Concussion
• Implication that there is no significant injury to
the brain
– Trauma to the head with a variable period of
unconsciousness or confusion and then a return to
normal consciousness

22. Combat Trauma 22Head Injury
ConcussionConcussion

23. Combat Trauma 23Head Injury
Cerebral Contusion
• Bruised brain tissue
• History of prolonged unconsciousness or
serious alteration in state of consciousness
• Brain swelling may be severe and rapid
• Question CVA
• Personality Changes
• Altered LOC

24. Combat Trauma 24Head Injury
Side ofSide of
ImpactImpact
Contusion

25. Combat Trauma 25Head Injury
Intracranial Hemorrhage
• Three major types
– Epidural hematoma
– Subdural hematoma
– Intracranial hematoma
• Signs and symptoms
– Change in level of consciousness
– headache
– Decreased pulse rate
– Increased blood pressure
– Change in pupil size and reaction

26. Combat Trauma 26Head Injury
Treatment of Brain Injuries

27. Combat Trauma 27Head Injury
Treatment of Brain Injuries
• Manage IV fluids, as indicated
• Assess for shock
• Apply a dressing/bandage being careful not to
compromise the airway

28. Combat Trauma 28Head Injury
Treatment of Brain Injuries
• If brain tissue is exposed, apply a sterile dressing.
Local protocol dictates moist or dry sterile
dressing.
• Administer high flow Oxygen
• Reassess neurologic status and vitals
• Stabilize impaled object
• Support with suction of secretions as needed if
available
• Administer wound care

29. Combat Trauma 29Head Injury
Treatment of Brain Injuries
• Administer pain control as needed
• Full spinal immobilization
• Transport in head raised position by elevating the
top of the litter or spinal board.
• Raise head of bed 30 degrees

30. Combat Trauma 30Head Injury
Summary
• Anatomy of the head and central nervous system
• Rapid assessment
• Treatment of decreased level of consciousness
• Rapid Transport
• Frequent reassessment