A head injury can range from mild to severe and is caused by blunt force trauma or penetrating injuries to the skull and brain. Symptoms of a serious head injury include loss of consciousness, persistent headaches, vomiting, or abnormal behavior. Treatment depends on severity but may include monitoring for deterioration, supporting circulation and lowering intracranial pressure by evacuating hematomas or reducing brain swelling.

1. Head injuries

4. • A head injury is any trauma that leads to
injury of the scalp, skull, or brain. These
injuries can range from a minor bump on
the skull to a devastating brain injury.

5. • Head injury can be classified as either closed or
penetrating.
• In a closed head injury, the head sustains a
blunt force by striking against an object
• In a penetrating head injury, an object breaks
through the skull and enters the brain. (This
object is usually moving at a high speed like a
windshield or another part of a motor vehicle.)

6. • Learning to recognize a serious head
injury, and implementing basic first aid,
can make the difference in saving
someone's life.
• In patients who have suffered a severe
head injury, there is often one or more
other organ systems injured. For example,
a head injury is sometimes accompanied
by a spinal injury.

7. Pathophysiology
• Direct trauma.
• Cerebral contusion.
• Intracerebral shearing.
• Cerebral edema.
• I.C.H
• Hydrocephalus

8. Traumatic Head Injury

10. Cerebral Edema
• Cellular response to injury
– Primary injury
– Secondary injury
• Hypoxic-ischemic injury
– Injured neurons have increased metabolic needs
– Concurrent hypotension and hypoxemia
– Inflammatory response

11. The main factors which determine the
severity of cerebral injury are:
• Distortion of the brain.
• Mobility of brain in relation to skull
and meninges.
• Configuration of interior of skull.
• Deceleration and acceleration.
• The pre-existing state of brain
(elderly).

12. Brain injury:
– Concussion.

13. Contusion
Laceration

14. The Secondary pathology:
• Intracranial :
– Brain swelling.
– Necrosis. Ischemia.
– Hematoma.
– Vascular changes.
– Coning.
– Coup & Counter-coup.

15. • Extracranial :
– Resp. failure, increase CO2.
– Systemic B/P
– Fluid, isotonic.
– Temperature

16. • For a mild head injury, no specific treatment
may be needed. However, closely watch the
person for any concerning symptoms over the
next 24 hours.
• The symptoms of a serious head injury can be
delayed. While the person is sleeping, wake him
or her every 2 to 3 hours and ask simple
questions to check alertness

17. • If a child begins to play or run immediately
after getting a bump on the head, serious
injury is unlikely. However, as with anyone
with a head injury, closely watch the child
for 24 hours after the incident.

18. • Signs of deterioration:
– Becomes unusually drowsy
– Develops a severe headache or stiff neck
– Vomits more than once
– Loses consciousness (even if brief)
– Behaves abnormally

19. Skull fractures
• Simple fracture.
• Comminuted linear fracture of the vault.
• Skull base linear fracture.
• Depressed fracture. by:
-falling objects.
-Assault with a heavy blunt tool.
-Missile injury.
-R.T.A

21. • Compound depressed fracture:
– Antibiotics.
– Anti tetanus prophylaxis.
– Surgery. Urgent.
• Closed depressed fracture

22. Closed depressed fracture
Indication of surgery:
• Dural tear
• Brain compression...
(Dural venous
sinuses.)
• Compound.
• Cosmetic.

23. Missile injuries:
• Scalp injury.
• Depressed skull fracture.
• I.C.H.
• Brain injury.

24. Management of Traumatic Head Injury
• Maximize oxygenation and ventilation
• Support circulation / maximize cerebral perfusion
pressure
CPP=MSP-ICP
• Decrease intracranial pressure
• Decrease cerebral metabolic rate

25. Monitoring
• Serial neurologic
examinations
• Circulation /
Respiration
• Intracranial Pressure
• Radiologic Studies
• Laboratory Studies

26. Circulatory Support:
Maintain Cerebral Perfusion Pressure
6
5
Number of 4 Good
Hypotensive Moderate
Episodes 3
Severe
2 Vegetative
1
Dead
0
Outcome
Kokoska et al. (1998), Journal of Pediatric Surgery,
33(2)

27. Lowering ICP
Brain Blood
CSF Mass
• Evacuate hematoma Bone
• Drain CSF
– Intraventricular catheters use is limited by
degree of edema and ventricular effacement
• Craniotomy
– Permanence, risk of infection, questionable
benefit

28. • Reduce edema
• Promote venous return
• Reduce cerebral metabolic rate
• Reduce activity associated with
elevated ICP

29. Management on head injuries
• Minor head injury

30. Indications for admission to hospital:
• Loss of consciousness.
• Persistent drowsiness.
• Focal neurological deficit.
• Skull fracture.
• Persisting nausea & vomiting
• Elderly & infant.
• W.

31. Management
• Observation.
• Bed elevated 20.
• Mild fluid restriction.

32. Severe head injury
• It depends on the patient’s neurological
state and the intracranial pathology
resulting from the trauma.
• Clinical assessment and CT scan
• Evacuation of any hematomas

33. • If there is no surgical lesion, or
following the operation:
– Observation and GCS chart
– Decrease intracranial brain swelling
• Airway management
• Elevation of the head of the bed 20º
• Fluid and electrolyte balance
• Blood replacement with colloid or blood and
not crystalloid
• No steroids

34. – Management of conditions resulted from
head injury
• Severe hyponatraemia due to excessive fluid
intake or inappropriate excessive secretion
of ADH
• Hypernatraemia due to inadequate fluid
intake.
• Diabetes insipidus

35. • Temperature control, pyrexia due to
hypothalamic damage or traumatic SAH
or infection or from CSF leak and
meningitis

36. – Nutrition:
• During the initial 2-3 days the fluid therapy
will include 1.5-2 liters of 5% dextrose
• After 3-4 days by nasogastric feeding

37. – Routine care of the unconscious patient,
bowel, bladder and skin.
– Intracranial monitoring in more severe
cases.