HEAD INJURY

dr. Emika Prastyan

CLASSIFICATION OF HEAD INJURY • MECHANISM : – BLUNT : HIGH VELOCITY. LOW VELOCITY – PENETRATING : GUNSHOT WOUNDS. OTHER • SEVERITY : • MILD : GCS 14-15 • MODERATE : GCS 9-13 • SEVERE : GCS 3-8 .

SUBDURAL. INTRASEREBRAL . DEPRESSED/NON DEPRESSED. WITH/WITHOUT NERVE VII PALSY. OPEN/CLOSSED.  INTRACRANIAL LESION : • FOCAL : EPIDURAL. • BASILAR : WITH/WITHOUT LEAK CSF.CLASSIFICATION (CONT) • MORPHOLOGY  SKULL FRAKTURES : • VAULT : LINIER/STELLATE.

CLASSIFICATION (CONT) • DIFFUSE : MILD CONCUSSION. DIFFUSE AXONAL INJURY . CLASIC CONCUSSION.

POST TRAUMATIC SYNDROME SOMATIC : • HEADACHES • DIZZNESS OR LIGH-HEADEDNESS • VISUAL DISTURBANCES : BLURRING IS COMMON COMPLAIN • DIMINISHED TASTE AND SMELL • HEARING DIFICULTIES : TINNITUS. REDUCES AUDITORY ACUITY. • BALANCES DIFFICULTIES .

POST TRAUMATIC SYNDROME COGNITIVE IMPAIRMENT • MEMORY DYSFUNCTION • IMPAIRED CONCENTRATION AND ATTENTION • SLOWING OF REACTION TIME • SLOWING OF INFORMATION PROCCESING SPEED • IMPAIRED JUDGMENT .

POST TRAUMATIC SYNDROME PSYCHOSOCIAL • IRRITABILITY • ANXIETY • DEPRESSION • PERSONALITY CHANGE • FATIQUE • SLEEP DISTURBANCES • DECREASED LIBIDO • DECREASED APPETITE .

RADIOLOGICAL EXAMINATIONS • • • • RO HEAD CT SCAN MRI ANGIOGRAFI .

ANTEROGRADE • HEADACHE : MILD. MODERATE. AGE. OCCUPATION • MECHANISM OF INJURY • TIME OF INJURY • LOSS OF CONSCIOUSNESS IMMEDIATELY AFTER INJURY • SUBSEQUENT LEVEL OF ALERTNESS • AMNESIA : RETROGRADE. RACE.MANAGEMENT OF MILD HEAD INJURY HISTORY : • NAME. SEX. SEVERE • SEIZURE .

MANAGEMENT OF MILD HEAD INJURY • GENERAL EXAMINATION TO EXCLUDE SYSTEMIC INJURY • LIMITED NEUROLOGICAL EXAMINATION • CERVICAL SPINE AND OTHER RADIOGRAPHS AS INDICATED • BLOOD ALKOHOL LEVEL AND URINE TOXIC SCREEN • CT SCAN OF THE HEAD IN ALL PATIENT EXCEPT COMPLETELY ASYMPTOMATIC AND NEUROLOGICALLY NORMAL PATIENT IS IDEAL .

MANAGEMENT OF MILD HEAD INJURY • OBSERVE IN/ADMITTED TO HOSPITAL – – – – – – – – – NO CT SCANNER AVAILABLE ABNORMAL CT SCAN ALL PENETRATING HEAD INJURY HISTORY OF LOSS CONSCIUOSNESS DETERIORATING CONSCIOUSNESS MODERATE TO SEVERE HEADACHE SIGNIFICANT ALCOHOLIC/DRUG INTOXICATION SKULL FRAKTURE CSF LEAK RHINORRHEA OR OTORRHEA .

MANAGEMENT OF MILD HEAD INJURY – – – – – SIGNIFICANT ASSOCIATED INJURIES NO RELIABLE COMPANION AT HOME UNABLE TO RETURN PROMPTLY AMNESIA HISTORY OF LOOS OF CONSCIOUSNESS .

MANAGEMENT OF MILD HEAD INJURY • DISCHARGE FROM HOSPITAL : – PATIENT DOES NOT MEET ANY OF CRITERIA FOR ADMISSION – DISCUSS NEED TO RETURN IF ANY PROBLEMS DEVELOP AND ISSUE A”WARNING SHEET” – SCHEDULE FOLLOW-UP CLINIC VISIT. USSUALY WITHIN 1 WEEK .

HEAD INJURY WARNING DISCHARGE INSTRUCTIONS IF ANY OF THE FOLLOWING SIGNS DEVELOPS. CALL YOUR DOCTOR OR COME BACK TO THE HOSPITAL • DROWSINESS OR INCREASING DIFFICULTY IN AWAKENING PATIENT • NAUSEA OR VOMITING • CONVULSIONS • BLEEDING OR WATERY DRAINAGE FROM THE NOSE OR EAR • SEVERE HEADACHES • WEAKNESS OR LOOS OF FEELING IN THE ARM OR LEG .

OR AN UNUSUAL BREATHING PATTERN .HEAD INJURY WARNING (CONT) • CONFUSION OR STRANGE BEHAVIOR • ONE PUPIL MUCH LARGER THAN THE OTHER. DOUBLE VISION. OR OTHER VISUAL DISTURBANCES • A VERY SLOW OR VERY RAPID PULSE.

MANAGEMENT OF MODERATE HEAD INJURY • INITIAL WORKUP – SAME AS FOR MILD INJURY.PLUS BASELINE BLOOD WORK – CT SCAN OF THE HEAD OBTAINED IN ALL CASES – ADMISSION FOR OBSERVATIONAFTER ADMISSION • FREQUENT NEUROLOGICAL CHECKS • FOLLOW-UP CT SCAN IF CONDITION DETERIORATES .

.MANAGEMENT OF MODERATE (CONT) • IF PATIENT IMPROVES (90%) – – DISCHARGE WHEN APPROPRIATE FOLLOW-UP IN CLINIC • IF PATIENT DETERIORATE (10%) – IF PATIENT STOPS FOLLOWING SIMPLE COMMANDS. REPEAT CT SCAN AND MANAGE PER SEVERE HEAD INJURY PROTOCOL.

EVENTS RELATED HEAD INJURY) • NEUROLOGICAL REEVALUATION: • EYE OPENING • MOTOR RESPONSE • VERBAL RESPONSE • PUPILLARY LIGH REACTIONS • DOLL’S EYE .INITIAL MANAGEMENT OF SEVERE HEAD INJURY • ASSESSMENT AND MANAGEMENT – ABC – PRIMARY SURVEY AND AMPLE HISTORY (ALLERGIES. MEDICATIONS. LAST MEAL. PAST ILLNESS.

INITIAL MANAGEMENT OF SEVERE HEAD INJURY (CONT) • THERAPEUTIC AGENTS – MANNITOL – ANTICONVULSANT – MODERATE HIPERVENTILATION .

INDICATION OF SURGERY • • • • EPIDURAL HEMORRHAGE SUBDURAL HEMORRHAGE INTRACEREBRAL HEMORRHAGE DEPRESSED FRAKTURE .

BARBITURATES)  TO DECREASE SECONDARY(OR DELAYED PRIMARY) DAMAGE (STEROID)  TO TREAT SYMPTOMS ASSOCIATED WITH BRAIN INJURY (SEDATIVE. ANTICONVULSANT. PRESSORS)  TO PREVENT OR TREAT BRAIN SWELLING (DIURETICS.TREATMENT GOAL PHARMACOLOGICAL AGENT :  TO GAIN PHYSIOLOGICAL CONTROL OF THE PATIENT IN ORDER TO OPTIMIZE SUBSTRATE DELIVERY TO THE BRAIN AND PREVENT PAROXYSMAL INCREASES IN INTRACRANIAL PRESSURE (PARALYTIC. ANALGESICS. NEUROPROTECTANT) . STIMULANTS)  TO PREVENT OR TO TREAT COMPLICATION OF BRAIN INJURY (ANTIBIOTIC.