head injury

Question 1

define head injury

Answer 1

injury usually from blow to back of the head

often associated with traumatic brain injury

can cause concussion or haematoma (If BV are torn)

Question 2

epidemiology of head injury

Answer 2

more men

33-50% <15yrs

increasing number >75yrs

severe traumatic brain injury (GCS <9) has bimodal presentation - 15-25yrs and 65-75yrs. Occurs in 11000 people/yr

Question 3

aetiology of head injury

Answer 3

falls

assaults

road traffic accidents

(falls and assults more minor, traffic more moderate-severe)

alcohol may be involved in up to 65%

Question 4

presenting symptoms of head injury

Answer 4

amnesia - retrograde and antegrade

post-traumatic seizure

vomiting

loss of consciousness

confusion

Question 5

investigations for head injury

Answer 5

examine the CNS

chart pulse, BP, temp, resp and pupils every 15mins

assess antegrade amnesia - loss from the time of injury

assess retrograde amnesia - events prior to the injury (extent correlates to severity, never occurs w/o antegrade)

CT head in <1hr if:

• GCS <13 on initial assessment or <15 2hr following injury
• focal neuro deficit
• suspected open or depressed skull fracture, or signs of basal skull fracture - periorbital ecchymosis (panda eyes/racoon sign), postauricular eccymosis (Battle’s sign), CSF leak through nose/ears, haemotympanum
• post-traumatic seizure
• vom >once

CT head <8hr if

• any loss of consciousness/amnesia
• AND
• >65yrs
• coagulopathy
• high impact head injury
• retrograde amnesia >30mins

CT cervical spine <1hr if:

• GCS <13 on initial assessment
• intubated
• definitive dx of cervival spine injury needed urgently (eg pre-op)
• pt having other body areas scanned eg multi-region trauma
• clinical suspicion of cervical spine injury AND >65yrs, high impact injury, focal neuro deficit, parasthesia in upper/lower limbs
• if any criteria not met AND following low risk criteria present - assess neck movement:
  
  • simple rear end motor vehicle collision
  • comfortable in a seated position
  • ambulatory since injury
  • no midline cervical spine tenderness
  • delayed onset of neck pain
• if unable to actively rotate neck 45degrees L and R, or low risk feature not present - plain XR of cervical spine <1hr - if XR technically inadequate, suspicious, or definitely abnormal -> CT

Question 6

signs of head injury

Answer 6

if pupils are unequal = raised ICP

low GCS

amnesia

focal neurological deficit

suspected open or depressed skull fracture

signs of basal skull fracture - periorbital ecchymoses (Racoon sign), postauricular ecchymosis (battle’s sign), CSF leak through nose/ears, haemotympanium

parasthesia in upper/lower limbs - cervical spine injury

shock

meningism