Head Injury Final (PDF)

Head injuries DIFFUSE INJURIES I- FOCAL HEAD INJURIES: 2- Skull fractures, occur when energy applied to skull causes a bony deformation. I- FOCAL HEAD INJURIES: 2- Skull fractures: A- Linear skull fracture: appears as thin lines radio graphically & no bony displacement. No t...

Head injuries DIFFUSE INJURIES I- FOCAL HEAD INJURIES: 2- Skull fractures, occur when energy applied to skull causes a bony deformation. I- FOCAL HEAD INJURIES: 2- Skull fractures: A- Linear skull fracture: appears as thin lines radio graphically & no bony displacement. No treatment is required for most linear skull fractures. I- FOCAL HEAD INJURIES: 2- Skull fractures: B- Comminuted skull fracture: A breakage of skull bone into multi ple fragments. Basal skull fracture otorrhea II- DIFFUSE BRAIN INJURIES 1- Concussion  This is a non-lethal head injury resulting from blunt trauma. This results in immediate & transient loss of consciousness, which is re versible in minutes to hours. Symptoms of Concussion :  Dizziness  Confusion  Headache  Visual disturbances (diplopia)  Nausea & Vomiting  Changes in V.S or respiratory  Amnesia patterns Head injuries Secondary injury primary injury refers to the initial trauma to brain & is the result of blunt or penetrating head trauma. It occur at the time of injury & are fixed anatomic facts as shearing of tissue & blood vessels, disruption of skull integrity.  Secondary injuries occur as a result of brain's physiologic response to primary event or injury. It include: 1- Hypotension related to bleeding. 2- Hypoxia 3-Hypercarbia related to altered breathing patterns Assessment of patients with head trauma Neurological examination Patients with GCS score of:  13-15 is classified as having Mild head injuries  9-12 is classified as having Moderate head injuries  3- 8 are described as having severe head injuries.  Any patients not obeying commands is considered to have a severe head injury even if Glascow Coma Score may be slightly higher than 8.  In patients with high intracranial pressure, one or both pupils may be very wide in response to bright colour. Radiologic Assessment  CT scanning for detecting presence of blood & fractures.  Plain X-rays of skull is done to evaluate patients with only mild neurologic dysfunction.  Magnetic Resonance Imaging (MRI) may demonstrate existence of lesions that could not be detected by CT. Management of head injured patients Measures to control increased ICP: ICP must be maintained below 20mmHg.  Hyperventilation: through oxygen mask or mechanical ventilation, to decrease PaC02, which causes cerebral vasoconstriction & lead to a decrease in intracranial pressure (because increase PaC02 is a vasodilator to cerebral vessels which produces increase cerebral blood flow and intracranial volume leading to increase in ICP) Provide pharmacologic therapy such as:  Mannitol, furosemide to promote osmotic diuresis.  Barbiturate therapy to decrease metabolic demand of brain & decreases ICP.  Steroids to prevent cerebral edema.  Anticonvulsants for early seizure activity, as seizure increase metabolic activity in the brain and lead to increase in ICP.  Analgesics for pain relief to decrease ICP.  Maintain normothermia to decrease metabolic demand of the brain.  Proper positioning to facilitate venous return: head of the bed at 3-degree angle, neutral head alignment, &minimal hip flexion.  Initiates measures to prevent the Valsalva Maneuver (stool softeners)  Avoid noxious stimuli (suctioning, painful procedures).  Continuous ICP monitoring  Frequent neurological assessment.