HEAD INJURIES
Definition:A head injury is any trauma to the scalp, skull or brain.
Trauma is a leading cause of death. Craniocerebral trauma is a major factor in many of those
deaths and is a common cause of neurologic deficits.
Patients with a mild head injury need medical follow-up and therapy, but those with moderate
to severe head injuries need intensive and often long-term rehabilitaion.
Causes of Head injuries
ng causes of head injuries are:
Types of Head Injuries
injuries.
Brain injuriesare categorised as being minor or major
Concussionis considered a minorbrain injury. The patient may not lose total consciousness
with this injury.
Majorbrain injuries include contusions and lacerations.
CT Types of Head Injuries
Concussion: A cerebral concussion after a head trauma is a temporary loss of neurologic
function from which there is complete recovery. There is no apparent structural damage, and
recovery occurs quickly.
It can be characterized by post-traumatic loss of consciousness lasting <24 hours. (usually
much less) although unconscious, the concussion patient is rarely deeply unresponsive
Although recovery usually takes place within 24 hours, mild symptoms, such as headache,
irritability, insomnia, and poor concentration and memory, may persist for months (Post
concussion syndrome).
Have a significant effect on activities of daily living and return to employment. Patient may
need cognitive retraining or psychologic support.
CT Types of Head Injuries
Contusion:Cerebral contusion is a more severe cerebral injury in which the brain is bruised,
with possible surface haemorrhage.
There is no puncture of the pia mater and may be concurrent with cerebral laceration, which
is tearing of the cortex.
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more marked i.e. lie motionless,feeble pulse, shallow respirations, skin cold and pale, there is
often involuntary evacuation of bowels and bladder, aroused with effort but soon slips back
into unconsciousness. The B/P and the temperature are subnormal, and the picture is
somewhat similar to that of shock.
CT Types of head injuriesS/S of contusion
The patient may recover consciousness completely or cerebral irritability( i.e. fully conscious
but easily disturbed by any form of stimulation, noises, light, and voice). Residual headache
and vertigo, impaired mentalityor epilepsy occurs as a result of irreparable cerebral damage.
Depending on the areas of damage, the patient may present in varying altered states of
consciousness:
A frontal contusion-May cause hemiparesis in alert patient
A temporal lobe contusion-may cause a patient to be agitated, combative, disoriented, and
aggressive.
A frontal-temporal contusion-may cause aphasia.
Brain-stem contusion-produces deep coma with decerebrateposturing and may terminate in
death.
CT Types of Head Injuries
cerebral oedema:
bruising leading to swelling, resulting in increased intracranial pressure
swelling from bleeding into the finite space of the cranial cavity from fluid shifting due to
inflammation secondary to the impact injury
haemorrhage:
could be caused by tearing of blood vessels in the brain, or due to tearing of the meninges and
destruction of associated vessels
Subdural haematoma results when blood accumulates between the dura mater and the
subarachnoid layer.
Epidural or extradural haematoma-between inner skull and the dura, compressing the brain
underneath.Subdural haematoma-between the dura mater and arachnoid
membraneIntracerebral haemorrhage-bleeding in the brain or the cerebral tissue with
displacement of surrounding structures
CT Types of Head injuries
fractures:can be openor closedfractures
linear fractureis a simple break in bone continuity
comminuted skull fxoccurs when 2 or more communicating breaks divide the bone into 2 or
more fragments
depressed fracturesresult when the bone is forced below the line of normal contuour from
collision with a moving object
basilar fracturesare serious and involve disruption of the bones of the cranial vault
INVESTIGATIONS
skull X-raysto reveal any fracture
can do a CAT scan(Computerized Axial Tomography) if equipment available
could do angiogram to see vessels and possible haematoma
Lumbar puncturesare contraindicatedin head injuries (*)
S/S of Head Injuries
lty breathing; slowing and irregularities of respiration
sure
Physical examination
Physical Exam:
ABNORMAL RIGIDITY-POSTURE
Management of Children and Adults in the Hospital:
1. Manage the airway--clear secretions, O2 prn, proper positioning (*)
2. Elevate HOB 20-30 degrees, keeping the head and neck immobile; turn on side (semi-prone)
as this promotes venous drainage within the cranial cavity and prevents increasing intracranial
pressure.
3. Check for bleeding and apply pressure--if a wound, shave the head and apply a sterile
dressing
patient assessment through the use of the Glasgow Coma Scale) every 15
minutes (*)
CT Management
5. Mannitol—(an osmotic diuretic) action is it increases the osmotic pressure of glomerular
filtrate, inhibiting tubular reabsorption of water and electrolytes, reducing and preventing
oedema (1.5-2gm/kg as a 15%-25% solution IV over 30-60 minutes)
It is used when there is known elevated ICPand is only a temporary measure--action lasts
from 3-10 hours
6. Give IVF (generally use an isotonic solution, may alternate fluids to meet pt. needs)--adults
about 60-80cc/hour; make patient NPO initially
CT Management
n; if need be, enema q 3rd day
10. Never give narcotics--rarely give anything for pain until absolutely sure it is safe
turn q2h, pressure area care, suction (carefullyas it may increase ICP);
mouth care q2h; IVF or NG feeding; eye care; ROM bid; catheter; position changes at least
q2h; etc.
Other possible medical management:
Decadron: actionis it decreases inflammation; is a corticosteroid is indicated for treatment of
cerebral oedema (*)
Other drugs:anticonvulsantsif having seizures-barbituratesmay be given to treat ICP that has
not responded to other treatments; (*)
muscle relaxants and sedationmay be used to decrease oxygen consumption by
relaxing/calming patient if patient is restless/agitated, has increased response noxious stimuli
Hyperventilation--can hyperventilate the patient to decrease a high ICP (*)
Oxygenation—same thing as above; providing adequate oxygen perfusion will prevent further
oedema due to hypoxia
CT Management
elevate a depressed skull fracture, relieving increased ICP
Burr Hole drilledthrough the cranium, allowing the haemorrhage or haematoma to drain if on
the outside of the dura; can be done to drain the ventricles where there is collection of
blood/fluid, also relieving high ICP
Burr Hole or open cranium (Craniotomy)to evacuate the clot
Preparation for Neurosurgery: (opening the skull)
shave and clean the head
Mannitol before surgery
all the usual preop care and prep. POST OP. MANAGEMENT
Glasgow Coma Scale) q15 min. X4h and then q1h X24h, then q2h—with vital
signs
observe wound for haemorrhage; observe amount and colour of drainage, don't change
dressings without MD approval
light, balanced diet when able to feed orally; if swallowing reflex is absent pass an NG tube
I&O recording to help monitor fluid and electrolyte balance
CT Post op. management
in addition, all routine post-operative care! (remember to attend to nutrition, elimination, I&O,
vital signs, activity, hygiene, pressure area care, pulmonary needs, sleep,..all the patient’s
needs)
Health teaching
auma and head injury
observation of long-term complications
follow-up
Complications of Head Injury
e secretion of ADH
