HEAD INJURY

DR. JAYESH PATIDAR

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 INTRODUCTION
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 Head injury is a broad classification that includes

injury to the scalp, skull, or brain.
 Trauma involving the central nervous system can be
lifethreatening.
 brain and spinal cord injury may result in major
physical and psychological dysfunction and can alter
the patient’s life completely.

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 INCIDENCE
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 In the United States. Approximately 1 million people

receive treatment for head injuries every year.
 Of these, 230,000 are hospitalized,
 80,000 have permanent disabilities,
 and 50,000 people die

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 Count…
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Damage to the brain from traumatic injury takes two

forms:
 primary injury and secondary injury.
Primary injury is the initial damage to the brain
that results from the traumatic event.
Secondary injury
 evolves over the ensuing hours and days after the
initial injury and is due primarily to brain swelling or
ongoing bleeding.

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 SCALP INJURY
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 scalp trauma is generally classified as a minor head

injury.
 Because its many blood vessels constrict poorly, the
scalp bleeds profusely when injured.

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 SKULL FRACTURES
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 A skull fracture is a break in the continuity of the

skull caused by forceful trauma. It may occur with or
without damage to the brain. Skull fractures are
classified as linear, comminuted, depressed, or
basilar.

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 Type of skull fracture
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 Linear- breakn in continuty of bone without

alteration of relationshup of part.
 Depressed- inward indention of skull
 Simpal- without fragmentation or communication
laceration.
 Communicated- fragmentation of bone into many
pieces.

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 Clinical Manifestations
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 The symptoms, apart from those of the local injury,

depend on the severity and the distribution of brain
injury.
 frequently produce hemorrhage from the nose,
pharynx, or ears, and blood may appear under the
conjunctiva.
 (Battle’s sign)- An area of ecchymosis (bruising) may
be
seen over the mastoid
 A halo sign (a blood stain surrounded by a yellowish
stain) and is highly suggestive of a CSF leak.

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 9

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 Assessment and Diagnostic Findings
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 physical examination,
 a computed tomography (CT) scan
 the x-rays.
 Magnetic resonance imaging (MRI)

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 Management
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 Nondepressed skull fractures generally do not

require surgical treatment; however, close
observation of the patient is essential.
 Nursing personnel may observe the patient in the
hospital,

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 nasopharynx and the external ear should be kept

clean.
 a piece of sterile cotton is placed loosely in the ear, or
a sterile
 cotton pad may be taped loosely under the nose or
against the ear
 The head is elevated 30 degrees to reduce ICP

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 Brain Injury
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 The most important consideration in any head injury

is whethe or not the brain is injured.
 Significant brain damage secondary to obstructed
blood flow and decreased tissue perfusion. The brain
cannot store oxygen and glucose to any significant
degree.
 brain damage and cell death occur when the blood
supply is interrupted for even a few minutes

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 Type
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Closed (blunt) brain

 brain tissue is damaged, but there is no opening
through the skull and dura.
Open brain injury occurs when an object
penetrates the skull, enters the brain, and damages
the soft brain Tissue it opens the scalp, skull, and
dura to expose the brain.

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Pathophysiology
Brain suffers traumatic injury
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Brain swelling or bleeding

increases intracranial volume

intracranial pressure increases

Pressure on blood vessels within the brain

causes blood flow to the brain to slow

Cerebral hypoxia and ischemia occur

Intracranial pressure continues

to rise. Brain may herniate

Cerebral blood flow ceases

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Clinical Manifestations of Brain Injury
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 Altered level of consciousness

 Confusion
 Pupillary abnormalities (changes in shape, size, and
response to light)
 Sudden onset of neurologic deficits
 Changes in vital signs (altered respiratory pattern,
hypertension, bradycardia, tachycardia, hypothermia
or hyperthermia)

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 Vision and hearing impairment

 Sensory dysfunction
 Headache
 Vertigo
 Seizures

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Concussion
 A cerebral concussion after head injury is a
temporary loss of neurologic function with no
apparent structural damage.
 A concussion generally involves a period of
unconsciousness lasting from a few seconds to a few
minutes.

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Contusion
 Cerebral contusion is a more severe injury in
which the brain is bruised, with possible surface
hemorrhage.
 The patient is unconscious for more than a few
seconds or minutes. Clinical signs and symptoms
depend on the size of the contusion and the amount
of associated cerebral edema.

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 Intracranial Hemorrhage
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 Hematomas (collections of blood) that develop

within the cranial vault are the most serious brain
injuries hematoma may be epidural (above the dura),
subdural (below the dura), or intracerebral (within
the brain)

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 EPIDURAL HEMATOMA (EXTRADURAL
HEMATOMA OR HEMORRHAGE)
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 After a head injury, blood may collect in the epidural

(extradural) space between the skull and the dura.
 This can result from a skull fracture that causes a
rupture or laceration of the middle meningeal artery,
 the artery that runs between the dura and the skull
inferior to a thin portion of temporal bone.
 Hemorrhage from this artery causes rapid pressure
on the brain.

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 SUBDURAL HEMATOMA
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 A subdural hematoma is a collection of blood

between the dura and the brain, a space normally
occupied by a thin cushion of fluid. The most
common cause of subdural hematoma is trauma

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 INTRACEREBRAL HEMORRHAGE AND
HEMATOMA
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 Intracerebral hemorrhage is bleeding into the

substance of the brain.
 It is commonly seen in head injuries when force is
exerted to the head over a small area (bullet wounds;
stab injury).
 These hemorrhages within the brain may also result
from systemic hypertension, which cause
degeneration and rupture of a vessel;

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 Diagnostic evaluation
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Management of Brain Injuries

 History
 Initial physical and neurologic examinations.
 CT and MRI
 Positron emission tomography
(PET scan) this method of scanning examines brain
function rather than structure.

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 TREATMENT OF INCREASED
INTRACRANIAL PRESSURE
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 As the damaged brain swells with edema or as blood

collects within
 the brain, a rise in ICP occurs
 maintaining adequate cerebralnoxygenation.
 Surgery is required for evacuation of blood clots,
 débridement and elevation of depressed fractures of
the skull,
 and suture of severe scalp lacerations.
.

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ICP is monitored closely; if increased, it is managed by

 maintaining adequate oxygenation,
 elevating the head of the bed,
 maintaining normal blood volume

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 SUPPORTIVE MEASURES
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 Treatment also includes ventilatory support, seizure

prevention, fluid and electrolyte maintenance,
nutritional support, and pain and anxiety
management.
 Protect the airway.

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 Severity of Injury
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 Amount of brain tissue damage

measure “severity

 Duration of loss of consciousness

 Initial score on Glasgow Coma Scale (GSC)

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 Mild injury
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 0-20 minute loss of consciousness GCS = 13-15

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 Moderate injury
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 20 minutes to 6 hours LOC GCS = 9-12

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 Severe injury
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 > 6 hours LOC GCS = 3-8

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 Diagnosis
NURSING DIAGNOSES
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Based on the assessment data, the patient’s major nursing

diagnoses
may include the following:
 Ineffective airway clearance and impaired gas exchange
related to brain injury
 Ineffective cerebral tissue perfusion related to increased
ICP
 Deficient fluid volume related to decreased LOC and
hormonal dysfunction
 Imbalanced nutrition, less than body requirements,
related to metabolic changes, fluid restriction, and
inadequate intake

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 Risk for injury (self-directed and directed at others)

related to seizures, disorientation, restlessness, or
brain damage
 Risk for imbalanced (increased) body temperature
related to damaged temperature-regulating
mechanism
 Potential for impaired skin integrity related to bed
rest, hemiparesis, hemiplegia, and immobility
 Disturbed thought processes (deficits in intellectual
function, communication, memory, information
processing) related to brain injury

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 Head and Spinal Cord Injury Prevention
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The most effective treatment for brain and spinal cord

injury is prevention. To decrease the incidence of these
devastating and catastrophic injuries, the following steps
should be taken:
 Drivers should obey traffic laws, particularly not
speeding or driving when under the influence of drugs or
alcohol.
 All drivers and passengers should wear seat belts and
shoulder harnesses. Children under 12 should be
restrained in an age/size-appropriate system in the back
seat.
 .

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 Passengers should not ride in the back of pick-up

trucks.
 Motorcyclists, scooters, bicyclists, skateboarders,
and roller skaters should wear helmets

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 Educational programs should be directed toward
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violence and suicide prevention in the community.
 Water safety instruction should be provided. Steps
should be taken to prevent falls, particularly in the
elderly.

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 Athletes should use protective devices; coaches

should be educated in proper coaching techniques.
 Owners of firearms should keep them locked in a
secure area where children cannot access them.

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