Chapter 5 Head injuries

Chapter 5 Objectives Describe the anatomy of the head. Understand that head injuries can be prevented. Understand the urgency involved with caring for brain injuries. Describe the numerous types of head injuries.

Anatomy Skull has 28 bones Main function-protection of the brain Suture line is area where bones come together Only moveable joint in head is the mandible

The Brain Weighs only 3 pounds Requires 20% of the total blood oxygen and 15% of the blood supply of the body Brain cells grow and develop until age 18 After that, brain cells cannot be reproduced

The brain Lack of oxygen first causes unconsciousness and possibly death Pupils dilate Brain death can occur within 4-6 minutes 3.htmlhttp://faculty.washington.edu/chudler/color/pic 3.html

The brain Divided into lobes Named after bone that covers it Each lobe responsible for specific body functions Attaches to the spinal cord at the brain stem

The brain Cerebrospinal fluid covers the brain and spinal cord –Helps maintain regular pressure –Protects brain from impacts –Severe head injury can cause leakage of fluid, should not stop drainage… causes increased pressure and more brain damage

The scalp Part of the skin-covers skull Contains large # of blood vessels, muscles, and hair Skin –Protects against infections Hair –Protects skin from sun and keeps dirt and sweat away from eyes Blood vessels Even small cut causes profuse bleeding

The scalp Decreases force of impact due to additional padding Without a scalp it is believed that a skull could fracture with only 40 lbs of pressure With scalp, may take 425 lbs Do not judge head injury by amount of bleeding

Preventing Head Injuries Protective measures –Helmets –Mouth guards –Rules –Common sense

Mouth guards Often forgotten Impact to chin drives mandible into maxilla and causes brain stem to twist slightly, causing loss of consciousness Mouth guard provides shock absorption

Helmets and face masks Proper tackling skills important Recommend showing video to athletes on sport safety Explain signs, symptoms, and seriousness of head injuries to athletes

Mechanisms of Injury Impact –Most common –Temporal region most susceptible, thinnest area of bone –Contrecoup- brain is injured on opposite side of site of injury/direct blow Rotation –Can cause brain stem to stop functioning normally –Nerve receptors overload, causes unconsciousness, unconsciousness allows for a sorting of impulses

Skull fracture Significant force required Cause bleeding under skin, sometimes laceration

Types of skull fractures Depressed –Pushes portion of skull inside toward brain Linear –Goes across skull, causes tears in blood vessels on the inside of skull

Types of skull fractures Compound –Results in part of skull sticking through scalp, profuse bleeding Penetrating –Involves impaled object

Fractures Battle Sign –Result of skull fracture –Any skull fracture requires immediate physician referral

Concussions Temporary impairment of brain function caused by impact or rotational force

concussion Symptoms –Nausea –dizziness –headache –vomiting –difficulty speaking –tinnitus –loss of balance –Unconsciousness –Amnesia (retrograde or anterograde) –Possible battle sign –disorientation

Concussion grading Grade 1: –Transient confusion; –NO loss of consciousness; –Concussion symptoms clear in less than 15 minutes. Grade 2 –Transient confusion; –NO loss of consciousness; –Concussion symptoms or mental status abnormalities last longer than 15 minutes. Grade 3 –Any loss of consciousness, either brief (seconds) or prolonged (minutes). Source: (American Academy of Neurology)

Other concussion signs/symptoms Rapid eye movements/fluttering Unequal pupils Coma Increased blood pressure Decreased pulse rate Signs of shock Can lead to death or paralysis Consider possibility of neck injury

Other considerations Consider other possible injuries Monitor and see physician IMPACT testing

Intercranial hematoma Severe bleeding within the brain caused by blow to the head Usually over temporal or parietal regions Causes increased pressure on brain Death can occur Can be mistake for a concussion Only 40% survival rate if athlete goes into a coma Survival depends on early exam and prompt surgical care Physician drills hole in skull to drain blood, releases pressure, and attempts to repair blood vessel

Symptoms of intercranial hematoma Headaches Nausea Vomiting Loss of consciousness Paralysis of extremities on the opposite side of injury Battle sign Call EMS immediately

Signs of intercranial hematoma Rise in blood pressure Drop in pulse rate Pupil on same side of head injury dilated Difficulty speaking Difficulty using extremities on opposite side of the hematoma Stiffening of posture Rapid eye movements Lack of coordination Unconsciousness or coma

Post-concussion syndrome Persistence of symptoms –Headache –Tinnitus –Dizziness –Confusion –Should not last more than a week –Need to see physician

Second-Impact Syndrome Happens when athlete returns to activity too soon after concussion Second blow to head can cause loss of brain function and coma Importance of IMPACT testing