Head Trauma

Head Trauma Facts: 40% of multiple trauma victims have brain injuries. Brain injured patients have a death rate twice that of non-brain injured patients. Head injuries account for 25% of all trauma deaths and 50% of motor vehicle fatalities.

The Skull

Brain Injury Most brain injuries are not from direct injury to the brain. Most occur as a result of external forces against the skull or from movement of the brain inside the skull.

Deceleration Injuries The head strikes an object causing a sudden deceleration of the skull. The brain continues to travel forward and impacts the front of the skull. The brain then rebounds and strikes the rear of the skull.

Coup / Countercoup Coup is the original impact. Countercoup is the rebound impact. COUP CONTRECOUP

Skull Fractures

Brain Injuries Concussion Cerebral Contusion Intracranial Hemorrhage –( bleeding inside the skull)

Intracranial Pressure Injury to the brain can cause bleeding around the brain and/or swelling of the brain tissue. The brain cannot expand inside the skull, therefore pressure increases inside the skull - INTRACRANIAL

As ICP Increases: Cerebral perfusion pressure = mean arterial pressure - ICP As ICP increases, the blood pressure increases in an attempt to maintain Cerebral Perfusion Pressure - Cushing Reflex

Vital Signs Blood Pressure Pulse Respiration

Assessment of the Patient All patients with head or facial trauma have a cervical spine injury until proven otherwise!! Because head injured patients are often combative or have a decreased level of consciousness, a thorough assessment must be completed.

Don’t Be Trapped? Head injured patients are often under the influence of drugs and/or alcohol. Don’t let this influence your assessment and cause you to miss important information.

Also Head injured patients are also often uncooperative and/or aggressive even when not under the influence. Be patient and understanding! Resist making personal judgements about your patient.

Signs and Symptoms Mechanism of Injury Decreased level of Consciousness Bleeding or Fluid from Ears / Nose Watch the Vital Signs -Trend over Time

Signs & Symptoms (cont) Projectile Vomiting Seizures Unequal Pupils (late) Hemiparesis - weakness or paralysis on one side of the body Posturing

Management C-Spine Immobilization Airway management –have suction available High concentration oxygen or ventilate 12/min Manage bleeding from scalp lacerations –do not attempt to stop bleeding from ears / nose

Management (cont) Be prepared for seizures. If patient is on a backboard with C-Spine immobilization you can raise the head of the board slightly (4-6 inches) to possibly lower ICP.