2. Combat Trauma 2Head Injury
Introduction
• Most common for individuals working in
hazardous environments
• Delicate structures demand diligence in the care of
injured and damaged sensory organs
• Underlying structures may also be damaged
– Cranium
– Brain
– Trachea
– Neck vessels
– Cervical spine
3. Combat Trauma 3Head Injury
Anatomy and Physiology
of the Head
• Scalp
• Skull (cranium)
• Brain
6. Combat Trauma 6Head Injury
Rapid Trauma Assessment
• Look for obvious deformities
– Depressed Skull Fractures
– Lacerations
– All head injuries must be treated as if cervical spine
involvement
• Bleeding from ears and nose
– Clear fluid from ears and nose
– Swelling/discoloration behind ears
– Swelling/discoloration around both eyes
• Assess pupils
8. Combat Trauma 8Head Injury
Can the patient feel you
touching his fingers and toes?
9. Combat Trauma 9Head Injury
Neurological Exam
• Assess Neurologic status using the Glascow
Coma Scale (GCS)
– Severe head injury: GCS is < 9
– Moderate head injury: GCS is 9 to 12
– Minor head injury: GCS is 13 to 15
10. Combat Trauma 10Head Injury
Glasgow Coma Scale
EYE OPENING
Spontaneous Opening 4
Opens in Response to Speech Command 3
Opens in Response to Pain 2
NIL (No Response) 1
MOTOR RESPONSE (M)
Obeys Request to Move Some Part 6
Localizes (Moves Hand to Touched Place) 5
Withdraws Part From Painful Touch 4
Abnormal Flexion (Elbows, Wrists Bent) 3
Extensor Response (Arms, Legs Straight) 2
NIL (No Response) 1
11. Combat Trauma 11Head Injury
Glasgow Coma Scale
VERBAL RESPONSE (V)
Oriented (Answers Time, Place, Person) 5
Confused Conversation (MayBe Disoriented) 4
Inappropriate Words ("Mother," "Yesterday") 3
Incomprehensible Sounds (Groan, Moan, Scream) 2
NIL (No Vocal Response or Sounds) 1
12. Combat Trauma 12Head Injury
Nasal Injuries
• Signs and symptoms
• Special considerations
• Abrasions, lacerations, and punctures
• Avulsion
• Fully avulsed flaps of skin
• Septum Devaited
14. Combat Trauma 14Head Injury
Nasal Injuries
• Foreign objects
• Fully immobilize the spine
• Monitor vital signs, airway, and LOC
• Transport in a sitting position
15. Combat Trauma 15Head Injury
Nasal Injuries
• Nosebleeds (epistaxis)
– No signs or symptoms of skull fracture or spinal injury
– Conscious patient, place in a slightly forward, seated
position to allow for drainage.
– Unconscious patient or if signs and symptoms of spinal
injury are present, place on long spine board in
recovery position.
20. Combat Trauma 20Head Injury
Head Injuries
• Scalp wounds
• Skull injuries
– Linear nondisplaced fractures, compound fractures, or
depressed fractures
– Large contusion or darkened swelling of scalp
– Brain Injury
21. Combat Trauma 21Head Injury
Concussion
• Implication that there is no significant injury to
the brain
– Trauma to the head with a variable period of
unconsciousness or confusion and then a return to
normal consciousness
23. Combat Trauma 23Head Injury
Cerebral Contusion
• Bruised brain tissue
• History of prolonged unconsciousness or
serious alteration in state of consciousness
• Brain swelling may be severe and rapid
• Question CVA
• Personality Changes
• Altered LOC
27. Combat Trauma 27Head Injury
Treatment of Brain Injuries
• Manage IV fluids, as indicated
• Assess for shock
• Apply a dressing/bandage being careful not to
compromise the airway
28. Combat Trauma 28Head Injury
Treatment of Brain Injuries
• If brain tissue is exposed, apply a sterile dressing.
Local protocol dictates moist or dry sterile
dressing.
• Administer high flow Oxygen
• Reassess neurologic status and vitals
• Stabilize impaled object
• Support with suction of secretions as needed if
available
• Administer wound care
29. Combat Trauma 29Head Injury
Treatment of Brain Injuries
• Administer pain control as needed
• Full spinal immobilization
• Transport in head raised position by elevating the
top of the litter or spinal board.
• Raise head of bed 30 degrees
30. Combat Trauma 30Head Injury
Summary
• Anatomy of the head and central nervous system
• Rapid assessment
• Treatment of decreased level of consciousness
• Rapid Transport
• Frequent reassessment