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A head injury is any trauma to the scalp, skull or brain. The injury may serious or minor bump on
the skull. It can be either closed or open. By definition, trauma is required to cause a head injury,
but that trauma does not necessarily need to be violent. Falling down a few steps or falling into a
hard object may be enough to cause damage. Motor vehicle crashes account for about 17% of
traumatic brain injuries, while 35% are from falls. The majority of head injuries occur in males.
In this assignment I am going to discuss about the systematic assessment of a middle aged male
was lying on the ground after his motorcycle has hit the back of a car. He is bleeding profusely
from an open wound on his scalp. He also appears drowsy and groaning in pain. Penetrating head
injuries describe those situations in which the injury occurs due to a projectile, for example a
bullet, or when an object is impaled though the skull into the brain. Closed head injuries refer to
injuries in which no lacerations are present. The brain may also be injured without a direct blow
to the skull. The head sits on the neck allowing it to shake, causing the brain to slosh inside the
skull and become injured.
Most head injuries are mild head injuries. People presenting with mild head injuries will not have
any progression of their head injury. However a small percentage of mild head injuries progress
to more serious injuries. Mild head injuries may be separated into low-risk and moderate-risk
groups. Patients with mild-to-moderate headaches, dizziness, and nausea are considered to have
low-risk injuries. Many of these patients require only minimal observation after they are assessed
carefully, and many do not require radiographic evaluation. The treatment of moderate and
severe head injuries begins with initial cardiopulmonary stabilization. The initial resuscitation of
a patient with a head injury is of critical importance to prevent hypoxia and hypotension.

Steps for treating a head Injury

Pre hospital management

1. As with any injury, first assess and immediately provide care for any problems with
airway, breathing, and circulation (ABC's):
a. Keep the airway open
b. Provide supplemental high-flow oxygen if available
c. Control any serious external bleeding
d. Rescue breathing or CPR if indicated

Basic and Advanced Trauma Life Support, and Basic and Advanced Paediatric Life
Support as necessary. In severe traumatic brain injury the time from injury to definitive
neurosurgical care plays a crucial role, best outcomes being in those who achieve this
within four hours.[4] Other factors pertinent to all cases and especially to severe traumatic
brain injury:[4]
o Airway - endotracheal intubation should only be performed by those experienced
and with concomitant anaesthesia (risk of increasing intracranial pressure).
Insertion of laryngeal mask airways is easy and provides a good seal around the
o Breathing - oxygen should be provided with an aim to beginning ventilation as
soon as possible. End tidal CO2 monitoring is advisable, as hyperventilation is
associated with poorer outcomes, probably relating to cerebral vasoconstriction.
o Circulation - the systolic blood pressure should be maintained >90 mm Hg
ensuring an adequate cerebral perfusion pressure - eg, boluses of 0.9% normal


Safe helmet removal requires proper instruction and practice. A helmet needs to be
removed only if it:
a. Impedes assessment or treatment of ABC's
b. Prevents proper immobilization of the spine

c. Is loose and prevents the head from being stabilized or secured to a backboard

Conduct a rapid trauma survey and locate other significant injuries.

D- Deformities
C- Contusions
P- Punctures/ Penetrations
B- Burns
T- Tenderness
L- Lacerations
S- Swelling

A significant head injury is likely to have an associated spinal injury, so take

spinal precautions beginning with your initial assessment. Handling Suspected
Spinal Injuries. Head injury patients require a cervical collar and a backboard.
Minimize movement.

Full cervical spine immobilisation

Attempted (unless other factors prevent this) if:[2]
a. GCS is <15 at any time since the injury.
b. There is neck pain or tenderness.
c. There is focal neurological deficit.
d. There is paraesthesia in the extremities.
e. Any other clinical suspicion of cervical spine injury exists.

An alerting call to the destination A&E department should be made for all patients with a
GCS <15.[2]

Call for immediate evacuation

Do not give anything to the patient by mouth.

Monitor vital signs and level of responsiveness every 15 minutes for stable
patients and every 5 for unstable patients.

All head injuries should be evaluated by a physician. Serious symptoms can

develop over the following 48-72 hours.

Because patients can lose consciousness, obtain information regarding identity,

emergency contacts, allergies, medical problems and medications taken and last
time they ate and drank while waiting for evacuation.