Head Injury Flashcards
Head injury
Any trauma to the scalp, Skull, or brain
Includes…. an alteration in consciousness no matter how brief
Cause of Head injury
MVA Firearms Falls Assault Sports Recreational accidents Substance abuse
High potential for poor outcomes (DEATH) 3 times
- Immediately after injury
- Within 2 hours after injury
- 3 weeks after injury
Types:
Scalp Lacerations
- The most minor type of head trauma
- Scalp is highly vascular-> profuse bleeding, blood vessels do not vasoconstrict as readily
- Major complication is INFECTION
Types:
Skull fracture
Linear or depressed -Swollen, eccymotic area on scalp -Possible scalp laceration Simple, comminuted or compound closed or open -depressed Direct and indirect Coup and Contrecoup
Basal Skull Fracture:
Anterior Fossa
- Rhinorrhea
- Bilateral ecchymotic eyes / Raccoon eyes
- May have injury to CN I
- May have facial fracture
Basal Skull Fracture:
Middle Fossa
Otorrhea or rhinorrhea
Battle signs
May have cranial nerve damage
Basal Skull Fracture:
Posterior Fossa
May have epidural hematoma
Cerebellar, brainstem or cranial nerve signs
-visual changes, tinnitus, facial paralysis , conjugate eye deviation
Skull fracture
Location of fracture alters the presentation of the manifestations
Frontal=Cranial nerve I
Temporal= Facial paralysis =Cranial nerve VIII
Deviated gaze
Battle sign
Nursing Care of Skull Fractures
Minimize CSF leak - Sit pt up 30-40* -Never suction orally; -never insert NG tube -NO q Tips -Caution pt not to blow nose Place sterile gauze /cotton ball around area Verify CSF leak: -Dextrostix : positive For glucose (HALO ring) -Monitor closely : resp status
Mild Traumatic brain injury
Occurs with head injury due/to contact and/or acceleration/deceleration forces
- Defined as a 13-15 on GCS measured 30 mins post injury
- Concussion
- A sudden transient mechanical head injury with disruption of neural activity and change in LOC
- Stretching of nerve fibres no structural alteration
- Brief disruption in LOC
- Anemias
- Headache
- Short duration
Hallmark symptoms of Mild traumatic brain injury
Confusion and amnesia
Often with preceding loss of consciousness
Minor head trauma:
Postconcussion syndrome
2 weeks to 2 months Persistent headache Lethargy Personality and behaviour changes Dizziness Fatigue Irritability Anxiety Insomnia Loss of concentration and memory Noise and light sensitivity
Major Head Trauma
Includes cerebral contusion and laceration
Severe trauma to the brain
Types of major trauma:
Contusion: bruising of brain within a focal area that maintains the integrity if the pia mater and arachnoid layers still intact
Lacerations: Involves actual tearing of the brain tissue
Intracerebral hemorrhage is generally associated with cerebral laceration
Diffuse Axonal Injury: DAI
Axonal Disruption is widespread throughout the cerebral hemisphere and anatomic interruption of neuronal pathways
-Process takes approx 12-24 hrs (for swelling to take place)
Loss of consciousness ^ICP
Clinical signs: DAI
Decreased LOC
^ICP
Abnormal posturing
Global cerebral edema
Layers of the brain
Skull
- Dura Mater
- Subdural Mater
- Arachnoid
- Subarachnoid
- Pia Mater
EPIDURAL Hematoma
Results from bleeding b/w the dura and the inner surface of surface of the skull
-Linear skull fracture
A neurologic emergency
Venous or arterial origin
- hx: Short period of unconsciousness followed by lucid interval and then rapid deterioration
Headache
^ Irritability to confusion
decreased LOC
Ipsilateral oculomotor paralysis -fixed pupils
Contralateral hemiparesis/hemiplegia
SUBDURAL HEMATOMA
Occurs from bleeding b/w the dura mater and arachnoid layer of the meningeal covering of the brain
- Usually venous in origin
- Much SLOWER to develop into a mass large enough to produce system
- May Occur spontaneously
- Prevalent in older pt with cerebral atrophy and alcoholics
Acute Subdural Hematoma
High mortality SIGNS w/i 48 hrs of the injury -Associated with major trauma (shearing forces) -Patient appears drowsy and confused -Ipsilateral oculomotor paralysis -Contralateral hemiparesis/hemiplegia Shows signs of ^ICP earlier
SUBACUTE Subdural Hematoma
Occurs w/i 2-14 days of injury
FAILURE to regain consciousness may be an indicator
-See in older pts
CHRONIC Subdural Hematoma
Develops over weeks or months after a seemingly minor head injury
- Fibroblast accumulate around the hematoma and encapsulates it
- Hemolysis of the clot liberates plasma proteins causing high osmotic pressure
- High osmotic pressure causes an influx of water and swelling of the mass
Diagnostic Studies:
CT scan *** best to determine test to determine
MRI
C-Spine
GCS
