HEAD INJURIES/HEAD TRAUMA

Classification
Head Injury
 Broad classification that includes injury/trauma
to the scalp, skull or brain.
 Can range from a minor bump on the skull to
serious brain injury
 Most serious form - TBI
SCALP INJURY
 Generally classified as a minor injury
 The scalp bleeds profusely when injured.
 Trauma may result in an abrasion, contusion,
laceration, hematoma beneath the layers of
tissue of the scalp and avulsion (teared off).
1 - Closed (blunt) brain injury
 Object did not break the skull
 Does not cause damage to dura mater/skull
2 - Open/penetrating head injury
 Occurs when the cranium is fractured &/or the
membranes that surround the brain are
breached
A coup injury is the result of a sudden, violent stop that
causes the brain to accelerate forward and hit the side
of the skull.

A countercoup injury, on the other hand, occurs when

the brain accelerates forward, hits the side of the skull,
and then bounces off the other side of the skull. In both
cases, the brain is damaged as it rubs against the inner
ridges of the skull.

Scalp wounds
 potential portal of entry of microorganisms
 Area is irrigated first before the laceration is
sutured

Skull fractures
 A break in the continuity of the skull caused by Types of Head Injuries
forceful trauma A - Concussion - a violent jarring/shocking injury to the
 It may occur with or without damage to the brain
brain  temporarily affects normal brain function
 there is a transient period of unconsciousness
Classification  person may feel dazed & may lose vision or
1. Simple - a crack in the skull balance for a while, vomiting, slurred speech
2. Comminuted - splintered or multiple fracture line
3. Depressed - occur when the bones of the skull are
forcefully displaced downward.
4. Basilar - fracture of the base of the skull

BRAIN INJURY
 The most important consideration in any head
injury is whether the brain is injured.
  Bleeding in the brain that collects & clots,
forming a bump
 In general, a rapidly developing hematoma
even if small, may be fatal, whereas a larger
but slowly developing one may allow
compensation for increases in ICP.

Classification
A - Epidural
 between the skull & the dura mater
 an extreme emergency
 results from a skull fracture that causes a
rupture or laceration of the middle meningeal
artery Characterized by brief loss of
consciousness
 IICP, herniation

B - Contusion - a bruise of the brain

 there is some bleeding in the brain, causing
swelling
 characterized by extravasation of blood vessels

B - Subdural
 between the dura & the brain (arachnoid)
 usually due to trauma & ruptured veins
 symptoms of IICP develops gradually

C - Intracerebral
 bleeding into the substance of the brain

C - Laceration - tearing of tissues

D - Diffuse axonal injury

 Axons are stretched & damaged
 By high-speed transportation accidents—
associated with shaken baby syndrome
 Causes permanent damage to nerves in the
brain

Hematoma Causes
Common causes  Battle’s sign (bruising over the mastoid
1. Falls process that is typically the result of head
2. Motor vehicle crashes trauma.) aka = mastoid ecchymosis
3. Being struck by objects  CSF otorrhea, CSF rhinorrhea
4. Physical assaults
5. Accidents at work, home & outdoors
6. While playing sports

Highest risk of TBI:

- 15 to 19 age group
- Males
Damage to the brain from traumatic injury takes 2
forms: Assessment & Diagnostic tests
Primary injury Secondary injury ◼Neurologic history
initial damage to the evolves over the ensuing ◼X-ray
brain that results from hours & days after the ◼CT scan
the traumatic event initial injury ◼MRI
◼Cerebral angiography
includes contusions, results from inadequate
lacerations, & torn blood delivery of nutrients & Management
vessels oxygen to the cells ◼Close observation of the patient
◼Monitor LOC, respiratory status & maintain patent
airway
Pathophysiology
◼Notify the physician if drainage from the ears or nose
Brain suffers traumatic injury
is noted.
↓
◼Maintain head elevation
Brain swelling/bleeding inc. intracranial volume
◼Assess cranial nerve function
↓
◼Monitor for IICP
Rigid cranium allows no room for expansion
◼Do not take aspirin, ibuprofen, and anti-inflammatory
↓
medications
Slow blood flow to brain due to inc. pressure
◼Diuretics,
↓
◼Anti-seizure medications
Cerebral hypoxia & ischemia occur
▪ Ex, Dilantin, Phenytoin
↓
Intracranial pressure continues to rise. Brain may
◼Surgery
herniate
↓ ✔Needed to lessen intracranial pressure & brain
Cerebral blood flow ceases swelling
✔Remove fractured pieces of skull
Clinical Manifestations ✔Insert synthetic implants to protect brain tissue.
In any serious head trauma, always assume the spinal
cord is also injured. The best approach to head injury is
PREVENTION
 Chronic or severe headaches ◼Always use safety equipment during activities that
 Nausea & vomiting could result in head injury.
 Signs & symptoms of IICP ◼Obey traffic signals when riding a bicycle.
 Hemorrhage/fluid draining from the nose, ◼Be visible
pharynx, ears, conjunctiva ◼Use age-appropriate car seats or boosters for babies
 Weakness & paralysis & young children.
 Decreasing LOC ◼Make sure that children have a safe area in which to
 Decreased sensation, visual disturbances, play.
seizure ◼Do not drink & drive
 Memory loss, personality & behavior changes
First Aid
◼For mild head injury:
1. No specific treatment is needed.
2. Close monitoring is needed.
3. When person is sleeping, wake him/her q 2 to 3
hours & ask simple questions.

◼For moderate to severe head injury:

1. Treat as if there is spinal injury
2. Stop any bleeding by firmly pressing a clean
cloth on the wound.
3. If with skull fracture do not apply pressure
4. If the person vomits, roll the head, neck & body
as one unit to prevent choking.
5. Apply ice packs to swollen areas.