15.8 HEAD INJURY IN CHILD.pptx for nurses

for nursing students

1. HEAD INJURIES IN CHILDREN Presented by: Sharoon Rufan Lecturer, NICON BSN,RN

2. OBJECTIVES: At the end of session the learners will be able to, Define HEAD INJURY Indicate etiology Discuss pathophysiology Explain types of head injuries Describe complications Enumerate management

3. HEAD INJURY A head injury is a broad term that describes a vast array of injuries that occur to the scalp, skull, brain, and underlying tissue and blood vessels in the head. Head injuries are also commonly referred to as brain injury, or traumatic brain injury (TBI), depending on the extent of the head trauma.

4. HEAD INJURY Is a pathologic process involving the scalp,skull,meninges or brain as a result of mechanical force. is a morbid state, resulting from gross or subtle structural changes in the scalp, skull, and/or the contents of the skull, produced by mechanical forces.

5. ETIOLGY The three major causes of brain damaging childhood ,in order of importance are : 1 . falls 2 . Motor vehicle injuries. 3 . Bicycle injuries Neurologic injuries accounts for the highest mortality rate, with boys usually affected twice as often as girls. Incomplete motor development contributes to falls at young ages and the natural curiosity and exuberance of children increase their risk for injury. Infants are often left unattended on beds, in high chairs and in other places from which they can fall.

6. PATHOPHYSIOLOGY The AVPU scale ( Alert, Voice, Pain, Unresponsive ) is a system, which is taught to healthcare professionals and first aiders on how to measure and record the patient's level of consciousness.

7. CLINICAL MANIFESTATION Raised, swollen area from a bump or a bruise. Small, shallow cut in the scalp. Headache. Sensitivity to noise and light. Irritability or abnormal behavior. Confusion. Lightheadedness or dizziness. Problems with balance.

8. TYPES OF HEAD INJURIES Concussion. Contusion. Laceration. fractures .

9. CONCUSSION Is the most common head injury , an alteration in mental status with or without loss of consciousness, which occurs immediately after head injury. The hallmark of concussion are confusion and amnesia. Pathogenesis is still unclear but it may be a result of shearing forces that causes stretching , compressions and tearing of nerve fibres , particularly in the area of the brain stem.

10. CONTUSSION Represents petechial hemorrhages or localized burusing along the superficial aspects of the brain at the site of impact or a lesion remote from the site of direct trauma. The major areas of the brain susceptible to contussion are occipital,frontal and temporal lobes. It may cause focal disturbances in strength , sensations or visual awareness in children .

11. LACERATION A laceration is a wound that is produced by the tearing of soft body tissue. This type of wound is often irregular and jagged. A laceration wound is often contaminated with bacteria and debris from whatever object caused the cut. Also describes & as actual bruising and tearing of cerebral tissue. Is associated with penetrating or depressed skull fractures.

12. FRACTURES Skull fractures results from a direct blow or injury to the skull and are often associated with intra-cranial injury. The types of skull fractures are 1. linear 2.comminuted. 3. depressed. 4. open 5. basilar 6. growing fractures

13. DESCRIPTION Linear : This is the most common simple type. It is typically in the temporal or parietal area. Depressed : This is usually caused by a direct blow to the head and requires a neurosurgical opinion. A depressed skull fracture can sometimes be referred to as a ping-pong fracture. Open : An open fracture carries a high risk of infection. 

14. Conti…. Basal : Basal fractures involve any of the bones of the base of the skull. Basal fractures are more complicated due to underlying structures such as cranial nerves and sinuses which can lead to hearing loss, facial paralysis, or decreased sense of smell. They also can pose a risk for meningitis.

15. Conti… Growing : A growing fracture describes herniation of the brain through the broken dura following a skull fracture (often diastatic ). It usually presents later and grows as the brain herniates through the gap, as a persistent swelling or pulsatile mass. It is uncommon

16. COMPLICATIONS Seizures. Venous sinus thrombosis. Intra-cerebral bleed. Meningitis (if there is an open fracture). Growing skull fracture. Hemorrhage . Infection. Edema. Herniation .

17. DIFFERENTIAL DIAGNOSIS Brain laceration Epidural hematoma Frontal Lobe Syndromes Generalized Tonic- Clonic Seizures Hydrocephalus Open and depressed fracture Subdural Empyema Subgaleal hematoma

18. ASSESSMENT Rapidly assess the child's mental state using the  AVPU  scale. A  Alert V  Responds to voice P  Responds to pain     Purposefully Non-purposefully: Withdrawal/flexor response or extensor response U  Unresponsive Assess pupil size, equality and reactivity.

19. CONT.. History Time and mechanism of injury. Circumstances of injury, e.g. accident, unexplained fall (consider syncope). Loss or impairment of consciousness and duration. Nausea and vomiting. Clinical course prior to consultation - stable, deteriorating, improving. Other injuries sustained. Past history of bleeding tendency. Presence of amnesia. Post injury seizure. Presence of headache.

20. MEDICAL MANAGEMENT Asymptomatic patients may be discharged home to the care of reliable parents or guardians. If after initial evaluation there is headache or repeated vomiting, or there is a history of loss of consciousness at the time of trauma, a period of clinical observation, with reassessment, is indicated. In the child younger than two years of age, and particularly in children younger than 12 months of age, greater caution is advised.  All patients with moderate head trauma should undergo imaging by CT scan. Once the patient with a severe head injury has been stabilized, including intubation, a cranial CT scan should be performed.  Patients with severe head trauma require referral to a trauma centre with neurosurgical and paediatric critical care services.

21. NURSING MANAGEMENT Continuous monitoring of vital signs and, if possible, end-tidal CO 2 Mechanical ventilation to maintain normal oxygenation and ventilation Maintenance of a normal core temperature Providing sedation and analgesia, particularly during procedures and transport Fluid administration as required to maintain normovolemia and avoid hypotension.

22. PREVENTION Health care practitioners have numerous opportunities to provide age-appropriate anticipatory guidance around risk factors for head trauma in children. The CPS advocates for public policy and legislation to ensure, for example, helmet use in sporting activities, child restraint use in vehicles and the ban on baby walkers in Canada. Such measures have proven successful in reducing both the incidence and severity of head trauma in paediatric patients. Clinicians treating infants, children and youth should include injury prevention when counselling families .

23. REFERENCE Hockenberry , m and wilson , d. (2015) wong's nursing care of infants and children. 10th edition. Basis of pediatrics Manual of neonatal care,7 th ed , john p. Cloherty . Md,eric Eichenwald , md,anne r. Hansen, md , mph,ann r stark, md Basic of peadiatric 7 th edition ( pervez akber khan)