Head Trauma

Head Injuries: Account for about one half of all trauma

deaths Survivors range from baseline function to

severe morbidity Even “minor” head injury can have severe

impact As with most trauma, broken down into blunt

and penetrating

Anatomy of Nervous System The nervous system is composed of

Brain Spinal cord

The nervous system is divided into: Central nervous system (Brain & Spinal Cord) Peripheral nervous system

Physiology of Nervous System Cerebral Blood Flow (CBF) = 50 – 55

ml/100g of brain tissue/minute Main Arterial Pressure (MAP) = Diast. P +

1/3 Pulse P Intracranial Pressure (ICP) = 10 mm Hg Cerebral Perfusion Pressure (CPP) = 50 -150

mm Hg CPP = MAP – ICP

Injuries to the Brain & Skull Scalp injuries Skull injuries Brain injuries

Scalp Injuries Scalp has many blood vessels so injury may

bleed profusely. Control bleeding with direct pressure. Don’t apply pressure when there is possible

skull injury.

Skull injuries It include fractures to the

cranium and the face, can be associated with brain injury.

It is divided into: Open skull fracture:

cranium is fractures and scalp is lacerated.

Closed skull fracture: scalp is lacerated but cranium is intact.

Basal skull fracture

S & S of Skull Fractures and Brain Injuries

Visible bone fragments Altered mental status Deep lacerated or severe bruise

or hematoma Depression or deformity of the

skull Severe pain at site of injury Battle’s Sign Unequal or unreative pupils Raccoon’s eye Sunken eye Bleeding from the ears and/or

nose Clear fluid flow from ears and/or

nose

Personality change Increased blood pressure, decreased

pulse rate and widening pulse pressure (Cushing’s Syndrome)

Irregular breathing pattern Temperature increase Blurred or multiple vision Impaired hearing or ringing Equilibrium problems Forceful or projectile vomiting Posturing Paralysis or disability on one side of

the body Seizures Deteriorating vital signs

Brain Injuries Primary (Direct) Brain Injuries Secondary (Indirect) Injuries

Primary Brain Injuries It occur at the time of original insult Direct damage done to brain parenchyma and

associated with vascular injuries Brain tissue can be lacerated, punctured or

bruised by broken bones or foreign bodies Damage is already done Irreversible Damage control (debridement)

Secondary Brain Injury Damage that occurs after the initial insult

(ongoing injury processes) Expanding mass lesions, swelling or bleeding

quickly overwhelm buffers End result is increased intracranial pressure

(ICP) and/or herniation Diagnosis and treatments target minimizing

the effects of these indirect insults

Secondary Injury Mechanisms Mass effect and subsequent elevated ICP and

mechanical shifting leading to herniation Hypoxia Hypotension and inadequate CBF Cellular mechanisms

Intracranial Causes Herniation: displaced brain parenchyma

Damage to brain from trauma against the dura itself as well as producing ischemia as well

Cerebral Edema: intracellular fluid collection within neurons and interstitial spaces.

Intracerebral Hematomas

Brain Injuries – Brain Concussion Usually caused by blunt injuries. Injuries patient shows transient alteration in

neurologic function Mild injury usually with no detectable brain

damage. May have brief loss of consciousness. Headache grogginess and short memory loss

are common.

Brain Injuries – Brain Contusion A bruised brain or contusion can occur with

closed head injuries. Usually caused by blow that causes the brain

to hit inside the skull Unconsciousness or decreased level of

consciousness can occur

Brain Injuries – A hematoma Is a collection of blood within tissue. Hematoma inside the cranium is named according

to its location: Subdural hematoma: blood collection between brain and

dura Epidural hematoma: blood collection between dura and

the skull Subarachnoid Hemorrhage: Intracerebral hematoma: blood collection within the

brain

Epidural Hematomas

Blood between inner table of the skull and the dura

Lens shaped hematomas that do not cross suture lines on CT

Subdural Hematomas

Blood beneath the dura, overlying the brain and arachnoid, resulting from tears to bridging vessels

Crescent shaped density that may run length of skull

Very common in the elderly

Subarachnoid Hemorrhage Bleeding beneath the

arachnoid membrane on the surface of the brain.

Intracranial Hematoma Focal areas of

hemorrhage within the parenchyma

ER Care of Skull Fractures and Brain Injuries

Take appropriate body substance isolation precautions.

Assume spine injury Monitor conscious patient for

changes in breathing Apply rigid collar,

immobilize the neck and spine

Administer high concentration oxygen by NRM

Control bleeding

Keep patient at rest Talk to conscious patient

(emotional support) Dress and bandage open

wounds Mange the patient for

shock Be prepared for vomiting Transport patient promptly Monitor vital signs every

five minutes