Head injury

Head Anatomy

Brain Injuries
Primary
– Immediate damage to brain tissue
– direct result of injury force.
Secondary
– Result of hypoxia or decreased perfusion.

COMMON CAUSES
 Road accidents
 Falls
 Assaults
 Sporting accidents
 Work place accidents

Pathophysiology
Injury to the head
coup & contra coup
Blood oozes out from the artery and venous
Increased intracranial pressure
brain squeezes
out through foramen
magnum
Dereased cerebral perfusion
Cell death

Coup
– The “3rd collision”
– Area of original impact
Contracoup
– The “4th collision”
– Rebounding hitting the
opposite side

Brain Physiology
Intracranial pressure (ICP)
 Pressure of brain and contents in skull
•Cerebral perfusion pressure (CPP)
 Pressure required to perfuse brain
•Mean arterial pressure (MAP)
 Pressure maintained in vascular system

MONRO – KELLIE DOCTRINE

SYMPTOMS & SIGNS
 Diminishing level of consciousness
 Headache, vomiting, seizures
 Cushing’s Triad –
 bradycardia
 hypertension
 abnormal
respiration
 Pupillary changes

 Papilledema
 Rhinorrhea
 Otorrhoea
 battle sign
 raccoon eyes

CLASSIFICATION
 Mechanism
 Severity

MECHANISM
 BLUNT INJURY
 High Velocity
 Low Velocity
 PENETRATING INJURY
 Gunshot
 Sharp instruments

Glasgow Coma Scale
Suspect severe brain injury < GCS 9

Decorticate
 Arms flexed
and legs extended
Decerebrate
 Arms extended
and legs extended

Skull injuries
Types Skull injuries
 Linear nondisplaced
 Depressed
 Compound
Suspect fracture
 Large contusion or darkened
swelling
Management
 Dressing, avoid excess pressure

Brain Injuries
Concussion:
Brain shaking
No structural injury to brain
Diffuse axonal injury (DAI) is a frequent result of
traumatic acceleration/deceleration or
rotational injuries. which damage in the form of
extensive lesions in white matter tracts occurs over a
widespread area.
Contusion
Bruising of brain tissue

 Anoxic brain injury which is also called cerebral
hypoxia or hypoxic-anoxic injury(HAI) is a serious,
life-threatening injury; it can cause cognitive
problems and disabilities.
Intracranial hemorrhage
 Epidural
 Between skull and dura
 Subdural
 Between dura and arachnoid
 Intracerebral
 Directly into brain tissue
 Subarachnoid
 Between the arachnoid and pia mater

MANAGEMENT
 Detailed History
 Initial Assessment
 Primary Survey
 Secondary Survey

PRIMARY SURVEY
 Airway maintenance with cervical spine
protection
 Breathing and ventilation
 Circulation with hemorrhage control
 Disability
 Exposure

SECONDARY SURVEY
 Examination of Head, Neck and Throat
 Glasgow Coma Scale
 Detailed Neurological Examination
 Catheter Insertion
 Investication
 CBC, Blood grouping & typing
 X-ray, CT, MRI, ECG, ABG, & CBG.

 Mannitol 20%, 0.5–1 gm/kg
 Frusemide 0.3 – 0.5 mg/kg IV
 Moderate Hyperventilation (PCO2 25-35mmHg)
 Anticonvulsants
 Phenytoin-
Loading dose - 10 -15 mg/kg
Maintenance dose - 5 - 7mg/kg/day
 Sedation - Opiates

 Endotracheal intubation if GCS < 8
 Moderate hyperventilation.
 Treat shock aggressively
 Resuscitate with normal saline.
 Frequent neurological assessment.