Head Injuries Flashcards
What are the two classification of wounds?
Blunt Force
Sharp Force
What are blunt force wounds?
Abrasions
Bruises
Lacerations
What are sharp force wounds?
Incised wounds
Stab wounds
What are abrasions?
Light abrasion of epidermis
Tend to have no blood loss
No damage of blood vessels
What are bruises?
Different colours- release and breakdown of haemoglobin just under skin, degradation of haemoglobin through spectrum of colours
What are lacerations?
Edges irregular
Over bony regions
Hard to join together with stitches
What are incised wounds?
Longer than they are deeper
See where mechanism of injury has occurred
Deeper at entry wound, shallower as it goes on (tappers off)
What are stab wounds?
Deeper than they are wide (narrower)
If knife hits in intercostal spaces (between ribs)- lung puncture
What is the skull composed of?
Cranium- neurocranium and viscerocranium (viscero=organs)
Bones of face
N.B. The mandible is considered separaetely
What is a pneumatised bone?
A bone that is hollow or contains many air cells, such as the mastoid process of the temporal bone, frontal sphenoidal, ethmoidal
What is the weakest point of the skull?
Pterion
What is the Pterion?
Point of meeting in frontal, temporal and sphenoid
What is the zygomatic bones use?
Crash impact barrier to protect eyes from injury
What are the facial features?
Eyes Nore Maxilla- upper teeth Mandible Teeth
What are the 2 types of head injuries?
Primary
Secondary
What are primary head injuries?
SCALP S- Skin C-Connective tissue A- Aponeurosis L-Loose connective tissue P- Periosteam
What is aponeurosis?
Injury to scalp- takes off three layers off all in one
What are secondary head injuries?
Meningitis- menigis inflamed around brain and spinal chord
itis- inflammation
Ischaemia- reduction of blood supply
Increased ICP- intracranial pressure (trauma, bleeding, infections)
Oedema- swelling of brain
What types of skull fractures can you get?
Linear Hinge Comminutes Ring Distant
What are linear fractures?
Straight ish line
What are hinge fractures?
Back of skull, one of the skull moves relative to other
What are comminutes fracture?
Many different pieces (less common)
What are ring fractures?
Ring all the way around the skull (most serious)
What are distant fractures?
Impact at one point, skull fractures at different point
What are sutures?
Hold bits of skull together, allow for all the different moves to move over each other
What are CT scans useful for?
Bony injuries
What are MRI scans useful for?
Soft tissue damage
What is a basal skull fracture?
Generally occipital or temporal trauma
Only high impact injuries
What is the CSF rhinorrhoea?
Cerebrospinal fluid, hole between nose and brain
What is Battle’s sign?
Mastoid process, bleeding causes bruising
What is ‘Panda eyes’?
Or ‘racoon eyes’- blackened and bruised areas around eyes, blood leaking out of the brain
What are effects of basal skull fracture?
CSF rhinorrhoea
Battle’s sign
Panda/ racoon eyes
What is cerebral contusion?
A form of traumatic brain injury, is a bruise of the brain tissue. Like bruises in other tissues, cerebral contusion can be associated with multiple microhemorrhages, small blood vessel leaks into brain tissue. Contusion occurs in 20–30% of severe head injuries.
What is stripped from the brain in cerebral contusion?
Pia (lining around the brain)
What is the point of contact known as?
‘Coup’
What is the opposite point of impact?
Contrecoup
What is primary contact?
Being hit on the head
What is secondary contact?
Whiplash
What are the meninges?
Dura mater
Arachnoid mater
Pia mater
What types of intracranial haemorrhages are there?
Extradural haemorrhage
Subdural haemorrhage
Subarachnoid haemorrhage
Diffuse Axonal Injury (DAI)
What is extradural haemorrhage?
Above the dura under the surface of the skull
>90% associated with hashtag esp. at pterion
Usually middle meningeal artery
What are the effects of extradural haemorrhage?
Fine Initially have a lucid interval
A while after feel groggy, vomiting, takes time for dura to peel off skull
What is subdural haemorrhage?
Above arachnoid but below the dura mater
Venous in origin
Tearing of superior cerebral vein
Who is more likely to suffer from subdural haemorrhaging?
Alcoholics and the elderly more prone to subdural haemorrhage because of cerebral atrophy (peak IQ, greatest number of neurons late teens early 20s) older you get obtain cerebral atrophy, less nerves deteriorating
Why are the elderly more likely to suffer from subdural haemorrhaging?
Old age, brain starts ti shrink. As brain starts to shrink, veins shrink
Why are alcoholics more likely to suffer from subdural haemorrhaging?
Drink to much alcohol- kills brain and nerves, brain shrinks blood vessels grow
What is subarachnoid haemorrhage?
Occurs in natural disease or injury
AV (arterial venous) malformation (bad connections between arteries and veins) or rupture of Berry aneurysm (abnormal dilation of artery causing it to burst)
What is subarachnoid haemorrhaging associated with?
Trauma e.g. cranial fractures or cerebral lacerations
Internal carotid- linked to aorta
Carotid syphon- regulates blood pressure
What is Diffuse Axonal Injury (DAI)?
Diffuse brain injury without obvious lesion
Can’t diagnose until post-mortem
Can be unconscious straight away
What causes Diffuse Axonal Injury?
Due to shearing rotational forces (grey matter- where neurons are and white matter- where pathways are) separation of grey and white matter, weak point
How is DAI diagnosed?
Microscopic diagnosis
What is the Glasgow Coma Scale (GCS)?
Conscious Scale
How is the GCS marked?
Out of 15
Eye opening (4)- responsive/ unresponsive
Verbal response (5)- coherent
Motor response (6)- movement
Get 1 for no response- dead have 3 out of 15
