Head Injury

HEAD INJURY
DR. JAYESH PATIDAR

www.drjayeshpatidar.blogspot.com
30/04/2015
INTRODUCTION
2
Head injury is a broad classification that includes
injury to the scalp, skull, or brain.

Trauma involving the central nervous system can be
lifethreatening.
brain and spinal cord injury may result in major
physical and psychological dysfunction and can alter
the patients life completely.
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INCIDENCE
3
In the United States. Approximately 1 million people
receive treatment for head injuries every year.

Of these, 230,000 are hospitalized,
80,000 have permanent disabilities,
and 50,000 people die
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Count
4
Damage to the brain from traumatic injury takes two

forms:
primary injury and secondary injury.
Primary injury is the initial damage to the brain
that results from the traumatic event.
Secondary injury
evolves over the ensuing hours and days after the
initial injury and is due primarily to brain swelling or
ongoing bleeding.
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SCALP INJURY
5
scalp trauma is generally classified as a minor head
injury.
Because its many blood vessels constrict poorly, the
scalp bleeds profusely when injured.
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SKULL FRACTURES
6
A skull fracture is a break in the continuity of the
skull caused by forceful trauma. It may occur with or

without damage to the brain. Skull fractures are
classified as linear, comminuted, depressed, or
basilar.
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Type of skull fracture

7
Linear- breakn in continuty of bone without
alteration of relationshup of part.

Depressed- inward indention of skull
Simpal- without fragmentation or communication
laceration.
Communicated- fragmentation of bone into many
pieces.
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Clinical Manifestations
8
The symptoms, apart from those of the local injury,
depend on the severity and the distribution of brain

injury.
frequently produce hemorrhage from the nose,
pharynx, or ears, and blood may appear under the
conjunctiva.
(Battles sign)- An area of ecchymosis (bruising) may
be
seen over the mastoid
A halo sign (a blood stain surrounded by a yellowish
stain) and is highly suggestive of a CSF leak.
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Assessment and Diagnostic Findings

10
physical examination,
a computed tomography (CT) scan

the x-rays.
Magnetic resonance imaging (MRI)
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Management
11
Nondepressed skull fractures generally do not
require surgical treatment; however, close

observation of the patient is essential.
Nursing personnel may observe the patient in the
hospital,
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Count
12
nasopharynx and the external ear should be kept
clean.
a piece of sterile cotton is placed loosely in the ear, or
a sterile
cotton pad may be taped loosely under the nose or
against the ear
The head is elevated 30 degrees to reduce ICP
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Brain Injury
13
The most important consideration in any head injury
is whethe or not the brain is injured.

Significant brain damage secondary to obstructed
blood flow and decreased tissue perfusion. The brain
cannot store oxygen and glucose to any significant
degree.
brain damage and cell death occur when the blood
supply is interrupted for even a few minutes
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Type
14
Closed (blunt) brain

brain tissue is damaged, but there is no opening
through the skull and dura.
Open brain injury occurs when an object
penetrates the skull, enters the brain, and damages
the soft brain Tissue it opens the scalp, skull, and
dura to expose the brain.
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Pathophysiology
Brain suffers traumatic injury

15
Brain swelling or bleeding

increases intracranial volume
intracranial pressure increases
Pressure on blood vessels within the brain

causes blood flow to the brain to slow
Cerebral hypoxia and ischemia occur
Intracranial pressure continues
to rise. Brain may herniate
Cerebral blood flow ceases
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Clinical Manifestations of Brain Injury

16
Altered level of consciousness

Confusion
Pupillary abnormalities (changes in shape, size, and
response to light)
Sudden onset of neurologic deficits
Changes in vital signs (altered respiratory pattern,
hypertension, bradycardia, tachycardia, hypothermia
or hyperthermia)
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Count
17
Vision and hearing impairment
Sensory dysfunction
Headache
Vertigo
Seizures
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18
Concussion
A cerebral concussion after head injury is a
temporary loss of neurologic function with no
apparent structural damage.
A concussion generally involves a period of
unconsciousness lasting from a few seconds to a few
minutes.
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19
Contusion
Cerebral contusion is a more severe injury in
which the brain is bruised, with possible surface
hemorrhage.
The patient is unconscious for more than a few
seconds or minutes. Clinical signs and symptoms
depend on the size of the contusion and the amount
of associated cerebral edema.
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Intracranial Hemorrhage
20
Hematomas (collections of blood) that develop
within the cranial vault are the most serious brain

injuries hematoma may be epidural (above the dura),
subdural (below the dura), or intracerebral (within
the brain)
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21
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EPIDURAL HEMATOMA (EXTRADURAL

HEMATOMA OR HEMORRHAGE)
22
After a head injury, blood may collect in the epidural
(extradural) space between the skull and the dura.

This can result from a skull fracture that causes a
rupture or laceration of the middle meningeal artery,
the artery that runs between the dura and the skull
inferior to a thin portion of temporal bone.
Hemorrhage from this artery causes rapid pressure
on the brain.
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SUBDURAL HEMATOMA
23
A subdural hematoma is a collection of blood
between the dura and the brain, a space normally

occupied by a thin cushion of fluid. The most
common cause of subdural hematoma is trauma
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INTRACEREBRAL HEMORRHAGE AND

HEMATOMA
24
Intracerebral hemorrhage is bleeding into the
substance of the brain.

It is commonly seen in head injuries when force is
exerted to the head over a small area (bullet wounds;
stab injury).
These hemorrhages within the brain may also result
from systemic hypertension, which cause
degeneration and rupture of a vessel;
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Diagnostic evaluation
25
Management of Brain Injuries

History
Initial physical and neurologic examinations.
CT and MRI
Positron emission tomography
(PET scan) this method of scanning examines brain
function rather than structure.
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TREATMENT OF INCREASED
INTRACRANIAL PRESSURE
26
As the damaged brain swells with edema or as blood
collects within
the brain, a rise in ICP occurs
maintaining adequate cerebralnoxygenation.
Surgery is required for evacuation of blood clots,
dbridement and elevation of depressed fractures of
the skull,
and suture of severe scalp lacerations.
.
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Count
27
ICP is monitored closely; if increased, it is managed by

maintaining adequate oxygenation,
elevating the head of the bed,
maintaining normal blood volume
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SUPPORTIVE MEASURES
28
Treatment also includes ventilatory support, seizure
prevention, fluid and electrolyte maintenance,

nutritional support, and pain and anxiety
management.
Protect the airway.
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Severity of Injury
29
Amount of brain tissue damage
measure severity
Duration of loss of consciousness
Initial score on Glasgow Coma Scale (GSC)
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Mild injury
30
0-20 minute loss of consciousness GCS = 13-15
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Moderate injury
31
20 minutes to 6 hours LOC
GCS = 9-12
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Severe injury
32
> 6 hours LOC
GCS = 3-8
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Diagnosis
NURSING DIAGNOSES
33
Based on the assessment data, the patients major nursing

diagnoses
may include the following:
Ineffective airway clearance and impaired gas exchange
related to brain injury
Ineffective cerebral tissue perfusion related to increased
ICP
Deficient fluid volume related to decreased LOC and
hormonal dysfunction
Imbalanced nutrition, less than body requirements,
related to metabolic changes, fluid restriction, and
inadequate intake
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Count
34
Risk for injury (self-directed and directed at others)
related to seizures, disorientation, restlessness, or

brain damage
Risk for imbalanced (increased) body temperature
related to damaged temperature-regulating
mechanism
Potential for impaired skin integrity related to bed
rest, hemiparesis, hemiplegia, and immobility
Disturbed thought processes (deficits in intellectual
function, communication, memory, information
processing) related to brain injury
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Head and Spinal Cord Injury Prevention

35
The most effective treatment for brain and spinal cord

injury is prevention. To decrease the incidence of these
devastating and catastrophic injuries, the following steps
should be taken:
Drivers should obey traffic laws, particularly not

speeding or driving when under the influence of drugs or
alcohol.
All drivers and passengers should wear seat belts and
shoulder harnesses. Children under 12 should be
restrained in an age/size-appropriate system in the back
seat.
.
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Count
36
Passengers should not ride in the back of pick-up
trucks.
Motorcyclists, scooters, bicyclists, skateboarders,
and roller skaters should wear helmets
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Educational programs should be directed toward

37
violence and suicide prevention in the community.

Water safety instruction should be provided. Steps
should be taken to prevent falls, particularly in the
elderly.
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38
Athletes should use protective devices; coaches
should be educated in proper coaching techniques.

Owners of firearms should keep them locked in a
secure area where children cannot access them.
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39
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Head Injury

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HEAD INJURY

DR. JAYESH PATIDAR

Head injury is a broad classification that includes

injury to the scalp, skull, or brain.

In the United States. Approximately 1 million people

receive treatment for head injuries every year.

Damage to the brain from traumatic injury takes two

scalp trauma is generally classified as a minor head

A skull fracture is a break in the continuity of the

skull caused by forceful trauma. It may occur with or

Type of skull fracture

Linear- breakn in continuty of bone without

alteration of relationshup of part.

The symptoms, apart from those of the local injury,

depend on the severity and the distribution of brain

Assessment and Diagnostic Findings

a computed tomography (CT) scan

Nondepressed skull fractures generally do not

require surgical treatment; however, close

nasopharynx and the external ear should be kept

The most important consideration in any head injury

is whethe or not the brain is injured.

Closed (blunt) brain

Brain suffers traumatic injury

Brain swelling or bleeding

Pressure on blood vessels within the brain

Clinical Manifestations of Brain Injury

Altered level of consciousness

Vision and hearing impairment

Hematomas (collections of blood) that develop

within the cranial vault are the most serious brain

EPIDURAL HEMATOMA (EXTRADURAL

After a head injury, blood may collect in the epidural

(extradural) space between the skull and the dura.

A subdural hematoma is a collection of blood

between the dura and the brain, a space normally

INTRACEREBRAL HEMORRHAGE AND

Intracerebral hemorrhage is bleeding into the

substance of the brain.

Management of Brain Injuries

As the damaged brain swells with edema or as blood

ICP is monitored closely; if increased, it is managed by

Treatment also includes ventilatory support, seizure

prevention, fluid and electrolyte maintenance,

Amount of brain tissue damage

0-20 minute loss of consciousness GCS = 13-15

20 minutes to 6 hours LOC

> 6 hours LOC

Based on the assessment data, the patients major nursing

Risk for injury (self-directed and directed at others)

related to seizures, disorientation, restlessness, or

Head and Spinal Cord Injury Prevention

The most effective treatment for brain and spinal cord

Drivers should obey traffic laws, particularly not

Passengers should not ride in the back of pick-up

Educational programs should be directed toward

violence and suicide prevention in the community.

Athletes should use protective devices; coaches

should be educated in proper coaching techniques.

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