EAC Head injuries Flashcards
aims of pre-hospital treatment in pt’s suffering head injuries
The brain damage sustained at the time of injury cannot be treated.
YOUR JOB is to try and prevent it form getting worse.
This overrides treatment of relatively minor injuries.
Immediate removal to a hospital is vital.
ALWAYS CONSIDER C-SPINE. Is there clinical or mechanical indication?
Types of head injury
Scalp wound
Skull Fracture
Depressed Fracture of the Skull
Fractured Base of Skull
causation of:
Scalp Wound
Scalp wounds usually occur from direct violence e.g. assault, falls, RTC. The pt may be dazed or confused and could be suffering from concussion.
This type of wound usually bleeds quite considerably and in all directions, matting hair and running down the face. It can often be difficult to pinpoint the source and extent of the wound.
causation of:
Skull Fracture
Because fractures of the skull often involve brain damage, they are potentially serious incidents. Not only may the underlying brain be contused, but the risk of an intra-cranial blood clot is more then 60x greater when there is a skull fracture present. The skull may fracture in different places.
causation of:
Depressed Fracture of the Skull
This usually follows a direct blow and may be a closed or open injury. There may be a dent in the skull where the injury occurs. Careful handling is required to avoid any direct pressure to the site of the injury as underlying structures could be damaged.
causation of:
Fractured Base of Skull
A fractured base may be caused by indirect force. For example a blow or fall on the lower jaw, a fall onto the feet or lower part of the spine where the force is transmitted to the skull base.
A fractured base of skull may cause leak of cerebrospinal fluid CSF from the ear or nose. Signs might include a watery bloody discharge from the ear or nose or a bloodshot eye.
types of skull fracture:
Linear: where the break in the bone looks like a straight line
Depressed: where part of the skull is crushed inwards
Base of Skull: a fracture to the base of the skull
Open/compound: where the skin has broken and the surrounding tissue may be damaged
closed/simple: where the skin hasn’t broken and the surrounding tissue isn’t damaged
types of brain injury
Cerebral Contusion: bruising of the brain
Laceration: brain and tissue pulped or torn
Vascular damage: extradural haemorrhage or subdural bleeding
describe:
Cerebral Contusion
Bruising, swelling
Results form brain hitting skulls inside causing physical damage to brain tissue
Coup/Contra-coup pattern
Since brain is in closed box, pressure increases as brain swells, blood flow to brain decreases.
signs and symptoms of:
Cerebral Contusion
Personality changes Potentially prolonged confusion and loss of consciousness Paralysis (one side or total) Unequal pupils Vomiting
describe:
Epidural Haematoma
Usually associated with skull fracture in temporal area
Fracture damages artery on skull’s inside
Blood collects in epidural space between skull and dura mater
Since skull is closed box, intracranial pressure rises
signs and symptoms of:
Epidural Haematoma
Loos of Consciousness followed by return of consciousness (lucid interval)
Headache
Deterioration of consciousness
Dilated pupil on side of injury
Weakness, paralysis on side of body opposite injury
Seizures
describe:
Subdural Haematoma
Usually results from tearing of large veins between dura mater and arachnoid mater
Blood accumulates more slowly than in epidural haematoma
Signs and symptoms may not develop for days to weeks
signs and symptoms of:
Subdural Haematoma
Deterioration of consciousness
Dilated Pupil on side of injury
Weakness, paralysis on side of body opposite injury
Seizures
N.B. because of slow or delayed onset, may be mistaken for CVA
describe:
Cerebral Laceration
Tearing of brain tissue
Can result from penetrating or blunt injury
Can cause:
- Massive destruction of brain tissue
- bleeding into cranial cavity with increased intracranial pressure
