Head injuries, unconsciousness, seizures MUDr. Martin Kolář, Dept. of Anesthesiology and CCM, FNKV

Etiology of head trauma Falls Traffic accidents Sport Crime, war, … Head injury can be associated with: –Alcohol intoxication (masks severity of injury) –Spinal cord injury

Symptoms Loss of consciousness (short-term or prolonged) Headache Nausea and/or vomitus Injury of soft tissues Anisocoria

Symptoms Bleeding from nose or ear Raccoon eyes –unilateral – more likely periorbital contusion –bilateral – sign of cranial base fracture

Symptoms Palsy Loss of movement coordination Vertigo

When to call ambulance? Severe head or facial bleeding Bleeding from the nose or ears Severe headache Change in level of consciousness for more than a few seconds Black-and-blue discoloration below the eyes or behind the ears Cessation of breathing

When to call ambulance? Confusion Loss of balance Weakness or an inability to use an arm or leg Unequal pupil size Repeated vomiting Slurred speech Seizures

First aid Keep the person lying down with the head and shoulders slightly elevated Don't move the person unless necessary Avoid moving the person's neck. Stop any bleeding from wounded soft tissues Watch for changes in breathing and alertness –if the person shows no signs of circulation (breathing, coughing or movement), begin CPR

Soft tissues injury

usually severe bleeding –can result in haemorrhagic shock –bleeding from nose or mouth can result in chocking don't apply direct pressure to the wound if you suspect a skull fracture

Injury of the eye penetrating injury – do not remove the foreign body cover both eyes until definitive treatment –explanation: movenents of the healthy eye would worsen the damage of the injured eye caustics – rinse the eye well (several minutes under running water)

Unconsciousness serious sign, usually requires in-hospital treatment … … except common fainting –usually in dehydrated young women – decreased circulating volume –self-limiting disease – in horizontal position the brain perfusion is being restored rapidly –leg raise can expedite the recovery –if the unconsciousness persists, call ambulance

Management of unconscious patient check the responsiveness Are you OK? – any response – call for ambulance, check vital signs regularly – no response – continue according A-B-C, start CPR if necessary

Etiology of unconsciousness cardiac arrest –A-B-C … trauma –head injury, but also… –hypotension in e.g. haemorrhagic shock stroke –ischemic or haemorrhagic

Etiology of unconsciousness metabolic disorders –history of diabetes? – possible hypo-/ hyperglycemic coma –hyperglycemic coma – aceton smell in breath Kussmaul´s breathing – rapid deep breathing infections –fever –meningitis – typically petechias (red dots on skin)

Etiology of unconsciousness intoxication –check for characteristic smell in patient´s breath (e.g. alcohol) –suicide – check for empty drug bottles or blisters, suicide note –do not induce vomiting in unconscious patients – risk of aspiration hypothermia

Seizures - symptomatology alteration or absence of consciousness lip smacking tonic – clonic convulsions of the entire body or a body part (1/2 of face, unilateral extremities, …) –involuntary muscle contractions followed by relaxation tongue biting due to contraction of jaw muscle difficulty of breathing increased secretion of saliva from the mouth

Seizures - symptomatology after the seizure: –dizziness, desorientation –with gradual restoration of neurological functions

Seizures - treatment Do not leave the person having the seizure Protect the patient from any kind of injury Do not attempt to open the mouth and put anything in the mouth –choking hazard –injury of the rescurer Turn the patient to his/her side and allow any fluid to come out of the mouth

Seizures - treatment Do not attempt to give anything to drink or eat while the person is having a seizure Seizures usually last for a short period of time (1-2 minutes) If a seizure lasts longer than about five minutes, you should call an ambulance immediately

Febrile seizures usually in pre-school children tonic-clonic convulsions of the whole body, lasting for several minutes associated to infections with high fever, can be the first sign of infection occur during the febrile peak usually not dangerous, not a sign of epilepsy or any other serious disease warning: seizures in children without fever or infection