ENGLISH TASK FIRST AID FOR HEAD INJURY

Arrage by: 1. Anggie Yulianti Musyarofah 2. Budi Sari Dewi 3. Retno Wijayanti 4. Santi Nirmawati 5. Yuliska Isdayanti P27220011 162 P27220011 P27220011 P27220011 200 P27220011

HEALTH POLYTHECNIC OF SURAKARTA SURGEON NURSE 2013

1. Anggie Yulianti Musyarofah as Third speaker 2. Budi Sari Dewi as Second Speaker 3. Retno Wijayanti as Master of Ceremony 4. Santi Nirmawati as Moderator 5. Yuliska Isdayanti as First Speaker

A. HEAD INJURY Head injuries are one of the most common causes of disability and death in adults. The injury can be as mild as a bump, bruise (contusion), or cut on the head, or can be moderate to severe in nature due to a concussion, deep cut or open wound, fractured skull bone(s), or from internal bleeding and damage to the brain. A head injury is a broad term that describes a vast array of injuries that occur to the scalp, skull, brain, and underlying tissue and blood vessels in the head. Head injuries are also commonly referred to as brain injury, or traumatic brain injury (TBI), depending on the extent of the head trauma. Head injuries are rising dramatically, with around 1.47 million injured per year - about 52,000 of those dying. Five million Americans are alive today who have had a head injury and now need help with the activities of daily living, costing the country more than $56 billion per year. B. KINDS OF HEAD INJURY Head injuries can be classified as:

Open with bleeding wounds to the face or head Closed no visible signs of injury to the face or head.

1. Open Head Injury The brain controls all cognitive bodily functions, processes thoughts and emotions, and dictates personality. Damage to the brain can impair any of these functions and, in severe cases, can lead to a vegetative state or death. The skull, which is designed to protect this vital yet fragile organ, is very strong and can withstand incredible force; however, a severe blow to the head may fracture the skull and lead to permanent brain damage. An open head injury occurs when an object such as a bullet, backed by strong force, fractures the skull and damages brain tissue or the surrounding membranes. Open head injury is a serious form of traumatic brain injury that requires immediate medical attention.

Because there is an open wound, open head injury victims may suffer from infection and contamination. Skull Fractures Open head injuries differ depending on the type of skull fracture, of which there are four:

Linear Skull Fracture Depressed Skull Fracture Basilar Fracture Diastatic Fracture

Linear Skull Fracture Linear skull fracture, or a crack in the skull, accounts for about 69 percent of all open head injuries. Because the injury does not penetrate brain tissue, most linear skull fractures are minor and require little treatment. Nonetheless, it is important to seek immediate medical attention after any traumatic brain injury, including a linear skull fracture. Depending on the location of the injury, patients with linear skull fractures may suffer a variety of complications, including blood vessel damage and leakage of cerebrospinal fluid from the nose and ears. Cerebrospinal fluid is an important protective element, acting as a cushion to the brain and spinal column; as a result, patients experiencing leakage of this clear liquid are at grave risk of serious injury and brain damage, and are therefore advised to seek immediate medical attention. Cerebrospinal fluid leakage occurs when a linear skull fracture extends into the sinus cavity. Patients with significant brain swelling may suffer from linear skull fractures as a result of the pressure on the skull. Depressed Skull Fracture Depressed skull fractures are often the result of a severe blow to the head with a blunt object. Unlike linear skull fractures, which only break the surface of the skull, broken skull fragments from depressed skull fractures penetrate or compress brain tissue and can cause severe brain damage.

Diastatic & Basilar Skull Fracture Typically seen in newborns and older infants, diastatic fractures occur when the skull's suture lines (areas where the bones fuse together during childhood) are widened. In extremely rare instances, victims may sustain breaks at the base of the skull, or basilar skull fractures. Fractures in this area can cause tears in the membranes holding the brain, which may cause leakage of cerebrospinal fluid from the nose and ears. Open Head Injury Complications Most open head injuries expose the brain to the outside environment, leaving victims extremely susceptible to infection. It is crucial to seek immediate medical attention after an open head injury to treat the risk of infection. If left untreated, infection can cause permanent brain damage or death. The most common type of infection resulting from open head injuries is meningitis, or infection of the membranes that surround the brain and spinal column. Caused by bacteria or viruses, meningitis is usually treated with aggressive antibiotics and drugs that reduce brain swelling (corticosteroids). In addition to meningitis, open head injury can leave the brain vulnerable to other complications, including:

Seizures Dementia Paralysis Coma Death

All traumatic brain injury victims also risk suffering from intracranial hematoma, or bleeding in the head or brain. Open Head Injury Treatment Open injury treatment depends largely on how badly the skull is fractured and the extent of brain damage. Magnetic resonance imaging (MRI), an intracranial pressure monitor (ICP),

or computed tomography (CT) scans can help detect complications and injuries that are not immediately apparent. Because open head injury victims are prone to infection, doctors often administer antibiotics to prevent or treat any infections. Initial Open Head Injury Treatment When an open head injury victim arrives at a hospital, doctors quickly assess visible injuries to the head such as external bleeding and skull fracture. Doctors also measure blood pressure, body temperature, heart rate and breathing. The extent of skull and brain damage can be determined with MRI, ICP or CT scans. After identifying and assessing the fracture, doctors then determine whether a patient needs surgery and/or rehabilitation for traumatic brain injury. Open Head Injury Surgery In order to repair the fractured skull and stop bleeding in the head, some open head injury victims need surgery. During the operation, a surgeon may remove bone fragments to minimize brain swelling and/or implant synthetic skull pieces to protect fragile brain tissue from further injury. Postoperatively, patients are monitored for secondary complications, such as intracranial pressure and brain swelling. Patients with high levels of intracranial pressure often need additional surgery to relieve pressure and drain blood that has accumulated beneath the skull. Surgeons drain the blood using a catheter, by drilling holes in the skull or by prescribing strong medications to reduce inflammation. Open Head Injury Rehabilitation A crucial component of traumatic brain injury treatment is rehabilitation. Many people need extensive long-term traumatic brain injury rehabilitation to regain important neurological functions, including cognitive thinking skills. This requires the help of several specialists.

Physiatrists, rehabilitation physicians who specialize in physical medicine, evaluate open head traumatic brain injury victims and prescribe appropriate rehabilitation plans.

Neuropsychologists, or doctors who specialize in brain structure and function, can treat the patient's changes in thinking and behavior following traumatic brain injury.

Physical therapists work alongside neuropsychologists to reestablish mobility and simple functions like standing up, walking, brushing one's teeth and using the bathroom.

Rehabilitation programs aim not only to treat brain injury victims but also to help their families cope with the tragedy. . Read more articles on this site to learn about closed head injury and other topics related to traumatic brain injury. 2. Closed head injuries

Closed head injury is another type of traumatic brain injury whose complications often differ from those associated with open head injuries The soft, jelly-like brain is protected by the skull. The brain doesnt fill the skull entirely it floats in a clear, nourishing liquid called cerebrospinal fluid. This fluid acts as a shock absorber, but its protective value is limited.

The kinetic energy of a small knock to the head or face can be absorbed by the cerebrospinal fluid, but a hard impact can smash the brain against the inside of the skull. This can bruise the brain or tear blood vessels. If blood and blood serum start to escape, the swelling is contained within the skull. Intracranial pressure (pressure inside the skull) can cause permanent damage by literally crushing the brain. C. SYMPTOM OF HEAD INJURY Blood is not a reliable indicator of the seriousness of a head injury. Apart from wounds, other symptoms of serious head injury can include:

Altered consciousness for example, the person may lose consciousness for short or longer periods or may be conscious again, but confused or drowsy. They may even have a brief seizure. They may also change by improving for a while and deteriorating again later.

Skull deformities compressions or deformities are signs of fractures. Clear fluid from the ears or nose a skull fracture, especially a fracture to the base of the skull, can allow cerebrospinal fluid to leak from the ears or nose.

Black eyes and bruised skin behind the ears this indicates that the force of the blow was sufficient to rupture blood vessels around the eyes and ears. Vision changes the pupils of the eyes may be dilated (enlarged) and be different sizes in a person with a serious head injury. The person may complain of double or blurred vision.

Nausea and vomiting these are common side effects of serious head injury and should always be considered important if they persist.

D. CAUSES OF HEAD INJURY Common causes of head injury are motor vehicle traffic collisions, home and occupational accidents, falls, and assaults. Wilson's disease has also been indicative of head injury. According to the United States CDC, 32% of traumatic brain injuries (another, more specific, term for head injuries) are caused by falls, 10% by assaults, 16.5% by being struck or against something, 17% by motor vehicle accidents, 21% by other/unknown ways. In addition, the highest rate of injury is among children ages 014 and adults age 65 and older. E. PROGNOSIS In children with uncomplicated minor head injuries the risk of intra cranial bleeding over the next year is rare at 2 cases per 1 million.[8] In some cases transient neurological disturbances may occur, lasting minutes to hours. Malignant post traumatic cerebral swelling can develop unexpectedly in stable patients after an injury, as can post traumatic seizures. Recovery in children with neurologic deficits will vary. Children with neurologic deficits who improve daily are more likely to recover, while those who are vegetative for months are less likely to improve. Most patients without deficits have full recovery. However, persons who sustain head trauma resulting in unconsciousness for an hour or more have twice the risk of developing Alzheimer's disease later in life.[9]

Head injury may be associated with a neck injury. Bruises on the back or neck, neck pain, or pain radiating to the arms are signs of cervical spine injury and merit

spinal immobilization via application of a cervical collar and possibly a long board. If the neurological exam is normal this is reassuring. Reassessment is needed if there is a worsening headache, seizure, one sided weakness, or has persistent vomiting. F. FIRST AID FOR HEAD INJURY Learning to recognize a serious head injury and give basic first aid can save someone's life. Get medical help right away if the person:

Becomes very sleepy Behaves abnormally Develops a severe headache or stiff neck Has pupils (the dark central part of the eye) of unequal sizes Is unable to move an arm or leg Loses consciousness, even briefly Vomits more than once

For a moderate to severe head injury, take the following steps: 1. Call 911 right away. 2. Check the person's airway, breathing, and circulation. If necessary, begin rescue breathing and CPR. 3. If the person's breathing and heart rate are normal but the person is unconscious, treat as if there is a spinal injury. Stabilize the head and neck by placing your hands on both sides of the person's head. Keep the head in line with the spine and prevent movement. Wait for medical help. 4. Stop any bleeding by firmly pressing a clean cloth on the wound. If the injury is serious, be careful not to move the person's head. If blood soaks through the cloth, do not remove it. Place another cloth over the first one. 5. If you suspect a skull fracture, do not apply direct pressure to the bleeding site, and do not remove any debris from the wound. Cover the wound with sterile gauze dressing.

6. If the person is vomiting, to prevent choking, roll the person's head, neck, and body as one unit onto his or her side. This still protects the spine, which you must always assume is injured in the case of a head injury. Children often vomit once after a head injury. This may not be a problem, but call a doctor for further guidance. 7. Apply ice packs to swollen areas. A more serious head injury that involves bleeding or brain damage must be treated in a hospital. For a mild head injury, no treatment may be needed. Be aware though, symptoms of a head injury can show up later. Follow the instructions below under Home Care. DO NOT

Do NOT wash a head wound that is deep or bleeding a lot. Do NOT remove any object sticking out of a wound. Do NOT move the person unless absolutely necessary. Do NOT shake the person if he or she seems dazed. Do NOT remove a helmet if you suspect a serious head injury. Do NOT pick up a fallen child with any sign of head injury. Do NOT drink alcohol within 48 hours of a serious head injury.

When to Contact a Medical Professional Call 911 right away if:

There is severe head or face bleeding The person is confused, tired, or unconscious The person stops breathing You suspect a serious head or neck injury, or the person develops any signs or symptoms of a serious head injury

G. Head Injury Self-Care at Home Many people who hit their heads do not need to seek medical attention. People often hit their heads on a cupboard or trip and fall on a soft surface, get up and dust themselves off and are otherwise well. Occasionally, a bump can occur underneath the skin of the scalp or forehead. This 'goose egg' is a hematoma on the outside of the skull and is not necessarily related to any potential bleeding that can affect the brain. Treatment is the same as any other bruise or contusion and includes ice, and over-the-counter pain medication.