2. Salient features of Head Injury
Most common cause of death
following road traffic
accidents.
Outcome of traumatic brain
injury
not only personal loss
neuro-reahabilitaion
long term nursing care
supportive care
3. Pathophysiology of brain Injury
Cerebral autoregulation
normal blood flow – 55ml/100g/min
mean arterial pressure 50-150 mmHg
6. Primary vs Secondary brain Injury
Primary brain Injury
At the time of impact
Brainstem and hemispheric contusions
Diffuse axonal injury
Cortical lacerations
7. Primary vs Secondary brain Injury
Secondary brain Injury
sometime after the impact
often preventable
causes
Hypoxia PO2<8kPa
Hypotension SBP<90mmhg
Raised ICP >20mmhg
Pyrexia
Cerebral Perfusion Pressure <65mmhg
Metabolic Disturbances
8. Classification Of Head Injury
Blunt vs Penetrating
Morphological
Skull Fractures
Vault –
open / closed
linear / communited
depressed / non depressed
Base of skull fracture
Intracranial Hematoma
EDH / SDH/ SAH/ ICH
9. Clinical Features
Rule out multisystem injury esp spinal injury
Rule out non accidental causes of collapse
syncope
aneurysmal SAH
hypoglycemia
electrolyte imbalance
medications and drug abuse
10. Clinical Features
A – Airway
B- Breathing
C- Circulation
D- Disability assesment
Pupils and GCS
19. Clinical Features
Small hematomas with
little mass effect –
conservative
management
Surgery inappropriate
best GCS
pupillary reactivity
age
anticoagulant drugs