This document defines and describes head injuries, including types of injuries such as closed and open head injuries. It discusses mechanisms of primary and secondary brain injuries. It also outlines signs and symptoms, diagnosis including imaging tests, and treatment for both the acute and chronic stages. Treatment in the acute stage focuses on the ABCDE approach, increasing ICP management, and surgery if needed. Long term complications and prevention methods are also mentioned.
3. 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.
4. HEAD INJURY - TYPES
OPEN HEAD INJURY:
There is penetration to the skull.
CLOSED HEAD INJURY
There is NO penetration to the skull.
5. COUP-CONTRECOUP INJURIES
• Damage may occur
directly under the site
of impact (COUP), or it
may occur on the side
opposite the impact
(CONTRECOUP).
6. HEAD INJURY - MECHANISMS
PRIMARY INTRACRANIAL INJURY
• It is the initial neuronal
damage that occurs
IMMEDIATELY as result of
trauma.
SECONDARY INTRACRANIAL
INJURY
• Secondary injuries are the
result of the
neurophysiological and
anatomic changes, which
occur from MINUTES to
DAYS after the original
trauma.
9. SKULL INJURIES
CLOSED FRACTURES
• A closed fracture has a
significant chance of
associated intracranial
haematoma.
OPEN FRACTURES
• Open fractures have
potential for serious
infection.
• Any foreign matter impaled
in the skull should be left in
place for removal by the
neurosurgeons.
• Cover it lightly with a sterile
dressing that has been
moistened with a sterile
saline.
17. HEAD INJURY (DIFFUSE) -
CONCUSSION
• Brain injury that does
not result in any
evidence of structural
alteration.
• Return of consciousness
moments or minutes
after impact.
• There may be brief
confusion,
disorientation,
headache, dizziness,
amnesia.
• CT scan is normal.
26. SIGNS
A sign of ↑ICP
(INTRACRANIAL PRESSURE)
CUSHING REFLEX
↑ Blood Pressure
↓ Pulse Rate
↓ Respiratory Rate
27. SIGNS
• 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).
DILATED PUPIL
29. 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
30. 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
43. TREATMENT - ACUTE STAGE
CERVICAL IMMOBILIZATION
• Philadelphia Collar
44. TREATMENT - ACUTE STAGE (AIRWAY)
ENDOTRACHEAL INTUBATION
• If intubation is impossible:
Laryngeal Mask or
Cricothyrotomy are
indicated.
SIGNS OF ↓OXYGEN
• Respiratory rate < 10 or >40
bpm.
• S02 <90% breathing oxygen
or <85% breathing air
• Hypercarbia that implies
pH<7.2
• Hypoxia Pa02<50 mm Hg
49. TREATMENT - ACUTE STAGE
(CIRCULATION)
• Establish IV access with
two large-bore(14- or16
gauge) IV cannulas.
• IV infusion of Normal
Saline (NS).
• IV Norepinephrine
• AVOID giving 5% Dextrose
unless hypoglycaemia is
present.
• Dextrose ↑cerebral
oedema
• If BP is normal AVOID
giving excessive volumes
of fluids that may
↑cerebral oedema.
50. TREATMENT - ACUTE STAGE
(DISABILITY)
TREATMENT FOR ↑ICP
• IV Mannitol (Osmotic
Diuretic)
• IV Furosemide
• Hyperventilation
51. TREATMENT - ACUTE STAGE
(DISABILITY)
TREATMENT FOR ↑ICP
• If there are no counter-
indications (hypovolaemia,
spine injury) place the
patient in
“Reverse-Trendelenburg”
position
REVERSE-TRENDELENBURG
52. TREATMENT - ACUTE STAGE
(DISABILITY)
• If significant agitation and after excluding
hypoxia, hypovolaemia or pain, as the cause of
agitation: IV Midazolam
53. TREATMENT - ACUTE STAGE
(EXPOSURE)
• AVOID ↓Body
Temperature
• ↑Body Temperature:
Cooling measures and
IV Paracetamol
• Pain medication: IV
Fentanyl
• Anti-Emetics
• Post-Traumatic
Seizures: IV Diazepam
55. TREATMENT - ACUTE STAGE
(CATHETERIZATION)
NASOGASTRIC TUBE
• Place a Nasogastric tube
(NG Tube) to decompress
the stomach and reduce the
risk of vomiting as
aspiration.
• AVOID NG Tube for patients
with facial injuries. The tube
could enter the brain
through a bony fracture.
56. TREATMENT - ACUTE STAGE
(CATHETERIZATION)
URINARY CATHETER
• Insert an indwelling urinary
catheter for hourly urine
output monitoring.
• AVOID insertion if injury is
suspected to the urethra.