CROSS-SECTION

HEAD INJURY - DEFINITION

• Any injury that results
in trauma to the SCALP,
SKULL or BRAIN.

• TRAUMATIC BRAIN
INJURY and HEAD
INJURY are often used
interchangeably.
 HEAD INJURY - TYPES
OPEN HEAD INJURY: CLOSED HEAD INJURY
There is penetration to the skull. There is NO penetration to the skull.
 COUP-CONTRECOUP INJURIES

• Damage may occur

directly under the site
of impact (COUP), or it
may occur on the side
opposite the impact
(CONTRECOUP).
 HEAD INJURY - MECHANISMS
SECONDARY INTRACRANIAL
PRIMARY INTRACRANIAL INJURY INJURY

• It is the initial neuronal • Secondary injuries are the

damage that occurs result of the
IMMEDIATELY as result of neurophysiological and
trauma. anatomic changes, which
occur from MINUTES to
DAYS after the original
trauma.
 HEAD INJURY - MECHANISMS
SECONDARY INTRACRANIAL
PRIMARY INTRACRANIAL INJURY INJURY

• Cerebral Laceration • Edema

• Cerebral Contusion
• Impaired Metabolism
• Epidural Hematoma
• Subdural Hematoma • Altered Cerebral Blood Flow
• Subarachnoid Hematoma
• Intracerebral Hematoma • Free Radical Formation
• Diffuse Axonal Injury
• Excitotoxicity
 SCALP INJURIES
LACERATIONS SUBGALEAL HEMATOMA
 SKULL INJURIES
CLOSED FRACTURES OPEN FRACTURES
• Open fractures have
potential for serious
infection.
• A closed fracture has a • Any foreign matter impaled
significant chance of in the skull should be left in
associated intracranial place for removal by the
haematoma. neurosurgeons.
• Cover it lightly with a sterile
dressing that has been
moistened with a sterile
saline.
 SKULL INJURIES
CT SCAN OT
 SKULL INJURIES
DEPRESSED FRACTURES/COMPOUND NON-DEPRESSED LINEAL
DEPRESSED FRACTURES FRACTURES
SKULL INJURIES - BASILAR SKULL
FRACTURE
 SKULL INJURIES - BASILAR SKULL
FRACTURE
RACCOON EYE
 SKULL INJURIES - BASILAR SKULL
FRACTURE
BATTLE’S SIGN
 SKULL INJURIES - BASILAR SKULL
FRACTURE
CSF LEAKAGE FROM THE EAR OR
BLEEDING FROM THE EAR CANAL NOSE
 BRAIN INJURIES
DIFFUSE FOCAL

• Contusion
• Brain Lacerations
• Concussion • Epidural haematoma
• Diffuse Axonal Injury • Subdural haematoma
• Subarachnoid haemorrhage
• Parenchymal haematoma
 HEAD INJURY (DIFFUSE) -
CONCUSSION
• Brain injury that does • There may be brief
not result in any confusion,
evidence of structural disorientation,
alteration. headache, dizziness,
amnesia.
• Return of consciousness
moments or minutes • CT scan is normal.
after impact.
HEAD INJURY (DIFFUSE) - DIFFUSE
AXONAL INJURY
BRAIN CONTUSION
 EPIDURAL HEMATOMA
SCHEMATIC CT SCAN
 SUBDURAL HEMATOMA
SCHEMATIC CT SCAN
 SUBARACHNOID HEMATOMA
SCHEMATIC CT SCAN
 INTRACEREBRAL HEMATOMA
SCHEMATIC CT SCAN
HEMATOMAS
 CEREBRAL EDEMA
NORMAL CT SCAN CEREBRAL EDEMA
 SIGNS
CUSHING REFLEX

↑ Blood Pressure
A sign of ↑ICP
(INTRACRANIAL PRESSURE)
↓ Pulse Rate

↓ Respiratory Rate
 SIGNS
DILATED PUPIL
• A UNILATERAL , FIXED
DILATED PUPIL indicates
neurologic deterioration
may be secondary to
hypoxia, hypovolaemia or
hypoglycaemia, due to
↑ICP, and compression of
the 3rd Cranial Nerve
(OCULOMOTOR NERVE).
SIGNS
 SIGNS
DECORTICATE POSTURING
• Arms Flexed
• Arms bent inward on the
chest
• Hands clenched into fists
• Legs Extended
• Feet turned Inward
• Score of 3 in the Motor
section of the Glasgow
Coma Scale
 SIGNS
DECEREBRATE POSTURING
• Head is arched back
• Arms Extended by the sides
• Legs Extended
• Patient is rigid with the
teeth clenched.
• Score of 2 in the Motor
section of the Glasgow
Coma Scale
 SYMPTOMS
• Confusion/Irritibility • Speech/Swallowing
Difficulty
• Drowsiness
• CSF Leakage
• Dizziness
• Ear Bleeding
• Nausea & Vomiting
• Numbness/Paralysis
• Amnesia
• Coma
SYMPTOMS
 ASSESSMENT OF ACUTE HEAD
INJURY
MONITOR
• Blood Pressure
• Heart Rate
• Respiratory Rate
• 02 saturation
• EKG
• Level of Consciousness
 GLASGOW COMA SCALE

Score of 3-8 indicates severe head injury and 9-12 indicates moderate head injury
 TREATMENT - ACUTE STAGE
CERVICAL IMMOBILIZATION

• Philadelphia Collar
 TREATMENT - ACUTE STAGE
TREATMENT FOR ↑ICP REVERSE-TRENDELENBURG

• If there are no
contraindications
(hypovolaemia, spine injury)
place the patient in
“Reverse-Trendelenburg”
position
 Head Injuries
All injuries to the head are potentially
dangerous, and always require medical
attention!

Pages 42-45
 First Aid for an Unconscious Victim
3 Rules of Treatment
1. Ensure the airway is open
and clear
2. Check and recheck the levels
of response
3. Examine thoroughly
4. If breathing and circulation
are intact place in recovery
position
5. Monitor until EMS arrives
Pages 42-45
 First Aid for Head Injury
Breathing in vomit while unconscious is the most common cause of death
after a head injury.
1st priority is to protect victim airway by tilting back the jaw.
Always assume they have spinal injury and protect their neck.
If not breathing – start CPR

Carefully apply direct pressure to any

scalp wounds that are bleeding.

Watch for vomiting.

Pages 42-45
First Aid for head injury cont’d

If they are conscious, lay on the floor with head and

shoulders slightly raised.
If unconscious, place them in the recovery position;
protect their neck.

Call 911.

Continue to watch their breathing, circulation and level

of consciousness until help arrives.
Even if they regain consciousness, insist they go to
hospital to be checked out.
 Concussion
Conscious If the victim regains
Unconscious
• Sit victim down, consciousness Victim
treat any minor
bruise or wound quickly
with a cold compress • Call 911
• Call a doctor
• WATCH for signs of • Open the airway,
abnormal behaviour. check breathing.
• Have the victim
rest.
• If victim doesn’t • Be prepared to
recover within a few resuscitate.
minutes – call a • If they do not
doctor recover
completely within
30 minutes – call
an ambulance.

Pages 43