HEAD INJURIES

 

HEAD INJURIES

Head Injuries are:

• Very common in Road Traffic Accidents
• Major Cause of death among youth
• Severity depends on Brain injury

 

Head Injuries Involve scalp, cranium, or underlying brain

• Scalp -- lacerations, contusions, abrasions
• Skull fractures -- vault / base, simple or compound,
• depressed or planar
• Brain Injury: Focal (intra-cranial haematoma, contusion)
• Diffuse (diffuse axonal injury)
• May be Open or Closed

Types of Head Injuries

1. Coup / Counter coup injury
2. Concussion
3. Cerebral Contusion
4. Cerebral Haemotoma or bleed
5. Epidural
6. Sub-dural
7. Sub-arachnoid
8. Intra-cerebral

 

Signs and Symptoms

• Headache
• Dizziness
• Nausea / Vomiting
• Amnesia
• Decreased responsiveness
• Confusion
• Irritability
• Loss of responsiveness

For HEAD INJURY patient :

1. First impression: Responsive or Unresponsive
2. Urgent Survey ABCDE
3. Open airway with C-spine
4. Check breathing: Ventilate; Oral airway; O2
5. Check carotid artery pulse – CPR if indicated
6. Control any major bleeding

INVESTIGATIONS FOR JEAD INJURY PATIENTS:

1. CBC
2. Blood Urea / Serum Creatinin
3. Serum Electrolytes
4. Blood Group / Cross Match
5. X-Ray Skull
6. CT Brain

MANAGEMENT OF HEAD INJURY PATIENTS :

MASK an Ambu bagging if indicated.

 

 

  ORAL AIRWAY if indicated in head injury patient.

 

  Nasal Airway if indicated in head injury patient.

 

Endotrachial intubation in head injury patient if indicated.

 

DO General Measures in Head Injury Patients

• Stabilize head
• Maintain body temp.
• Observe – seizures, vomiting, change in response
• Presume C-Spine injury – Cervical collar
• Open airway: administer oxygen
• Treat bleeding and shock
• Prevent aspiration of vomit / secretions
• Vital monitoring

Do Specific Measures in Head Injury Patients

• NG tube (Nasogastric tube) is passed in head injury patients the reason being risk of aspiration of gastric contents. By means of NG tube , stomach contents are emptied. Also in an unconscious patient with longterm t/m going on, it may be used for feeding purposes.
• Folley Catheter is passed to monitor urine output in head injury patients
• Manitol if evidence of cerebral edema
• Steroids
• Antibiotics administration for wounds
• Stitching of Scalp wounds if any

Specialized Management for Head Injury if there is hematoma formation , which is compressing brain tissue

Burr – Hole and evacuation of Haematoma