HEAD TRAUMA

Dr. Murk Niaz

GI Surgery Resident
■ Head injuries are among the most common types of trauma encountered in
emergency departments (EDs).
■ Many patients with severe brain injuries die before reaching a hospital; in
fact, nearly 90% of prehospital trauma-related deaths involve brain injury.
■ Approximately 75% of patients with brain injuries who receive medical
attention can be categorized as having mild injuries, 15% as moderate, and
10% as severe.
 Goal of Treatment

■ The primary goal of treatment for patients with suspected TBI is to prevent
secondary brain injury.
 Immediate Management
■ The most important ways to limit secondary brain damage and thereby improve a
patient’s outcome are to ensure adequate oxygenation and maintain blood
pressure at a level that is sufficient to perfuse the brain.
■ After managing the ABCDEs, patients who are determined by clinical examination
to have head trauma and require care at a trauma center should be transferred
without delay.
■ If neurosurgical capabilities exist, it is critical to identify any mass lesion that
requires surgical evacuation, and this objective is best achieved by rapidly
obtaining a computed tomographic (CT) scan of the head.
■ CT scanning should not delay patient transfer to a trauma center that is capable
of immediate and definitive neurosurgical intervention
■ Make every effort to enhance cerebral perfusion and blood flow by
reducing elevated ICP, maintaining normal intravascular
volume and MAP, and restoring normal oxygenation and
ventilation.
■ Hematomas and other lesions that increase intracranial volume
should be evacuated early.
■ Skull fractures can occur in the cranial vault or skull base.
■ They may be linear or stellate as well as open or closed.
■ Basilar skull fractures usually require CT scanning with bone-window settings for identification.
■ Clinical signs of a basilar skull fracture include periorbital ecchymosis (raccoon eyes),
retroauricular ecchymosis (Battle’s sign), CSF leakage from the nose (rhinorrhea) or ear
(otorrhea), and dysfunction of cranial nerves VII and VIII (facial paralysis and hearing loss),
which may occur immediately or a few days after initial injury.
■ The presence of these signs should increase the index of suspicion and help identify basilar
skull fractures.
■ Some fractures traverse the carotid canals and can damage the carotid arteries (dissection,
pseudoaneurysm, or thrombosis).
■ In such cases, doctors should consider performing a cerebral arteriography (CT angiography
[CT-A] or conventional angiogram)
Brain Death