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: There is penetration to the skull. CLOSED HEAD INJURY 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 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.

HEAD INJURY - MECHANISMS PRIMARY INTRACRANIAL INJURY Cerebral Laceration Cerebral Contusion Epidural Hematoma Subdural Hematoma Subarachnoid Hematoma Intracerebral Hematoma Diffuse Axonal Injury SECONDARY INTRACRANIAL INJURY Edema Impaired Metabolism Altered Cerebral Blood Flow Free Radical Formation Excitotoxicity

SCALP INJURIES LACERATIONSSUBGALEAL HEMATOMA

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.

SKULL INJURIES CT SCANOT

SKULL INJURIES DEPRESSED FRACTURES/COMPOUND DEPRESSED FRACTURES NON-DEPRESSED LINEAL FRACTURES

SKULL INJURIES - BASILAR SKULL FRACTURE

RACCOON EYE

SKULL INJURIES - BASILAR SKULL FRACTURE BATTLE’S SIGN

SKULL INJURIES - BASILAR SKULL FRACTURE BLEEDING FROM THE EAR CANAL CSF LEAKAGE FROM THE EAR OR NOSE

BRAIN INJURIES DIFFUSE Concussion Diffuse Axonal Injury FOCAL Contusion Brain Lacerations Epidural haematoma Subdural haematoma Subarachnoid haemorrhage Parenchymal haematoma

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.

HEAD INJURY (DIFFUSE) - DIFFUSE AXONAL INJURY

BRAIN CONTUSION

EPIDURAL HEMATOMA SCHEMATICCT SCAN

SUBDURAL HEMATOMA SCHEMATICCT SCAN

SUBARACHNOID HEMATOMA SCHEMATICCT SCAN

INTRACEREBRAL HEMATOMA SCHEMATICCT SCAN

HEMATOMAS

CEREBRAL EDEMA NORMAL CT SCANCEREBRAL EDEMA

SIGNS A sign of ↑ICP (INTRACRANIAL PRESSURE) CUSHING REFLEX ↑ Blood Pressure ↓ Pulse Rate ↓ Respiratory Rate

SIGNS A UNILATERAL, FIXED DILATED PUPIL indicates neurologic deterioration may be secondary to hypoxia, hypovolaemia or hypoglycaemia, due to ↑ICP, and compression of the 3 rd Cranial Nerve (OCULOMOTOR NERVE). DILATED PUPIL

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 Drowsiness Dizziness Nausea & Vomiting Amnesia Speech/Swallowing Difficulty CSF Leakage Ear Bleeding Numbness/Paralysis 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 If there are no contraindications (hypovolaemia, spine injury) place the patient in “Reverse-Trendelenburg” position REVERSE-TRENDELENBURG

Head Injuries All injuries to the head are potentially dangerous, and always require medical attention! Pages 42-45

First Aid for an Unconscious Victim  Ensure the airway is open and clear  Check and recheck the levels of response  Examine thoroughly  If breathing and circulation are intact place in recovery position  Monitor until EMS arrives 3 Rules of Treatment Pages 42-45

First Aid for Head Injury Breathing in vomit while unconscious is the most common cause of death after a head injury. 1 st 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 Sit victim down, treat any minor bruise or wound with a cold compress WATCH for signs of abnormal behaviour. If victim doesn’t recover within a few minutes – call a doctor If the victim regains consciousness quickly Call a doctor Have the victim rest. If they do not recover completely within 30 minutes – call an ambulance. Unconscious Victim Call 911 Open the airway, check breathing. Be prepared to resuscitate. Pages 43