Head trauma

1
 Overview

Globally it is estimated that the annual

incidence of TBI is approximately 200 cases
per 100.000 population
 Assessment of Head injury

• History
• Mechanism of injury
• Pre and post injury status
• Document / communicate
• Reassess
DIFFERENT TYPES OF INJURY

Head injury
Cranial injury
Brain injury
 HEAD TRAUMA

• Open
- skull compromised
- brain exposed

• Closed
- skull not compromised
- brain not exposed
 HEAD INJURIES

• Skull fractures
- linear
- displaced
- compound
 CRANIAL INJURY

• Linear
• Depressed
• Open
• Impaled object
 BRAIN INJURY

Primary
Direct(caused by forces of trauma)

Secondary
Indirect(caused by factors resulting by
primary injury)
 BRAIN INJURY
• Direct brain injury • Indirect brain injury
-immediate damage due to -result from hypoxia or
force decreased perfussion
-coup and contracoup -response to primary injury
-develops over hours
 BRAIN INJURY
• Focal • Diffuse
- cerebral contusion -conccusion
-intracranial hemorage -moderate diffuse
epidural hematoma axonal injury
subdural hematoma -severe diffuse axonal
-intracerebral hemorage injury
 BRAIN INJURY

• Cerebral contusion
- blunt trauma to the soft tissues
- capillary bleeding
-comon whith blunt head trauma
 BRAIN INJURY
• Intracranial hemorage
- epidural hematoma
(bleeding between dura
mater and skull)
-subdural hematoma
(bleeding beneath dura
mater within
subarachnoid space above
pia mater)
 BRAIN INJURY
• Signs and symptomes of intracranial
hemorage
- rupture of blood brain vessel
-similar to stroke symptoms
- signs and symptoms worsen over hours
 BRAIN INJURY

• Signs and symptoms of brain injuries

1.Upper brainstream compression
-ICP,reflex bradicardia,chein stoke,pupill
become small and reactive,decorticate
posturing
2. Lower brainstream compression
-hypotension,pupills became dilated
unreactive,ecg changes,loss of response to
pain stimulus
 BRAIN INJURY
MANAGEMENT
-AIRWAY
•Open it
– Maintain spinal motion restriction (as appropriate for the
mechanism of injury)
– Jaw thrust
•Clear it
– Use suction as needed
•Maintain it
– GCS of 9 or more?
– Able to maintain patency?
• Consider airway management as necessary
• If active airway management is required, monitor:
– Oxygen saturation (95% or higher)
– BP
– End-tidal carbon dioxide (ETCO2)
• Confirm proper tube placement
– Use two methods:
• Physiologic
• Mechanical
 MANAGEMENT

• Breathing
• Provide oxygen (100%)
– A single episode of hypoxia, O2 saturation
< 90%, worsens outcome in patients with TBI
• Assist ventilations (as needed)
– Maintain normal ETCO2 at 35 to 40 mm Hg
– Ventilation rates
• Adults: 10 to 12 breaths per min
• Pediatric: 12 to 20 breaths per min
– No routine hyperventilation
 MANAGEMENT

• Circulation
• - Control hemorrhage and prevent anemia:
EVERY RBC COUNTS!
• Maintain adequate BP and perfusion
• If BP is normal or elevated:
– IV of LR/NS
• If BP is decreased:
– IV of LR/NS bolus, with fluid titrated to maintain BP of 90 to 100 mm
Hg
• A single episode of hypotension, BP < 90 mm Hg, worsens
outcome in patients with CNS injury
Transport and destination
Minimal on-scene time
Supine position
Appropriate receiving facility
Frequent reassessment
GLASGOW COMA SCALE
QUESTIONS