2. Head Injury and added notes to support your reading.pptx

Head injuri

1. HEAD INJURY EDSON k.

2. HEAD INJURY Is any degree of injury to the head ranging from scalp laceration to loss of consciousness (LOC) with focal neurological deficits. A head injury is an injury 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.

3. Causes of head injuries RTA Falls Violence Physical assault Home accidents sports Gun shorts Abuse especially child abuse Explosive blasts Natural disaster

4. TYPES OF HEAD INJURIES Common head injuries include: 1. Concussion. is an injury to the head area that may cause instant loss of awareness or alertness for a few minutes up to a few hours after the traumatic event.

5. 2. Skull fracture. is a break in the skull bone. four major types of skull fractures are: i) Linear skull fractures. This is the most common type of skull fracture. In a linear fracture, there is a break in the bone, but it does not move the bone. These patients may be observed in the hospital for a brief amount of time, and can usually resume normal activities in a few days. Usually, no interventions are necessary

6. ii) Depressed skull fractures.  This type of fracture may be seen with or without a cut in the scalp. In this fracture, part of the skull is actually sunken in from the trauma. This type of skull fracture may require surgical intervention, depending on the severity, to help correct the deformity.

7. iii) Diastatic skull fractures.  These are fractures that occur along the suture lines in the skull. The sutures are the areas between the bones in the head that fuse when we are children. In this type of fracture, the normal suture lines are widened. These fractures are more often seen in newborns and older infants.

8. Iv) Basilar skull fracture.  This is the most serious type of skull fracture, and involves a break in the bone at the base of the skull. Patients with this type of fracture frequently have bruises around their eyes ( Raccoon eyes ) and a bruise behind their ear also known as Peri-auricular ecchymosis ( Battle's sign ). They may also have clear fluid draining from their nose ( rhinorrhea ) or ears ( otorrhea ) due to a tear in part of the covering of the brain. These patients usually require close observation in the hospital

9. 3. Intracranial hematoma (ICH).  There are several types of ICH, or blood clots, in or around the brain. The different types are classified by their location in the brain. These can range from mild head injuries to quite serious and potentially life-threatening injuries These include: epidural hematoma, subdural hematoma, Contusion or intracerebral hematoma.

10. 4. Scalp wounds or scalp lacerations

11. C lassification Primary or secondary Open or closed head injury Focal or diffuse Heamorrhagic or non Heamorrhagic

12. Primary Vs secondary injuries Primary Occurs at the time of impact Examples Fractures Extra dura hematoma Subdural hematoma Secondary Occurs later as the consequences of primary trauma Examples Cerebral edema Cerebral ischemia Cerebral infarct

13. Open Vs closed head injury Open Head injury that involves a fracture of the cranium Closed Any fracture where the cranium remains intact

14. S ymptoms Physical symptoms Unconsciousness Severe headache Repeated nausea and Vomiting Dizziness Seizures Weakness of a limb Numbness in arms and legs Dilated pupils Psychological symptoms Slurred speech Confusion Agitation Memory or concentration problems Amnesia about events prior to injury

15. Red flags Unconsciousness Seizures Repeated vomiting Slurred speech Numbness in arms or legs

16. Diagnostic measures Proper history taking and physical examination X-Ray Computerized tomography scan (CT Scan) Magnetic resonance Imaging (MRI) Electro encephalogram (EEG)

17. Taking history in head injury Mechanism of injury Loss of consciousness or amnesia Level of consciousness at scene or on transfer Evidence of seizure History of vomiting Pre existing medical condition Medications especially (anti coagulants)

18. Physical exam Glasgow coma scale Pupil size and response Signs of skull fracture Bilateral periorbital edema (raccoon eyes) Battles sign (bruising over mastoid) Cerebral spinal fluid rhinorrhea or otorrhea Full neurological exam; tone, power, sensation, reflexes

19. Initial management Advanced trauma life support (ATLS protocol) A trauma protocol that not only looks at assessment of injuries but also treatment of injuries Must be followed in every kind of trauma Components Primary survey Secondary survey Tertially survey

20. Primary survey Involves thorough trauma evaluation Air way (C spine stabilization) Breathing Circulation Disability (dysfunction) Exposure (external examination)

21. Secondary survey Once the patient has been stabilised after the primary survey and resuscitation. A detailed examination of the body systems must be performed. But giving special consideration to focused head injury evaluation Neurological Respiratory Gastro intestinal Genital urinary musculoskeletal

22. Neurological assessment

23. M anagement of HI Severe head injury is best managed in a neural intensive care setting The patient should be positioned with head up to 30 degrees It is vital to ensure that the cervical immobilization collar does not obstruct venous return from the head

24. Airway and ventilation Patient in traumatic coma is un able to protect there air way and is at a risk of aspiration Maintain Normocapnia (> 30mmHg <50mmHg)

25. Circulation and cerebral perfusion pressure Hypotension and hypoxia as a major cause of secondary brain injury A systolic BP<90mmHg worse outcome in traumatic coma Cerebral perfusion pressure should be maintained at > 65mmHg in severely head injured patients ( CPP= MAP- ICP)

26. Control of intracranial pressure Position head up to 30 degrees Avoid obstruction of the venous drainage from the head Sedation +/- muscle relaxant Normocapnia (36–40 mmHg; 4.8–5.3 kPa ) Diuretics: furosemide, mannitol Seizure control Normothermia barbiturates

27. Medication Osmotic diuretics Anticonvulsants Barbiturates Calcium channel blockers

28. Osmotic diuretics Mannitol 25% 1.5- 2g/Kg I.V infused over 30- 60minutes

29. A nticonvulsants Phenytoin Where it may inhibit spread of seizure activity in motor cortex Dosage 100mg IV or 150 – 200mg IM

30. Summary of non- surgical mgt I.V fluids Mannitol Anti epileptics Head elevation Analgesics Sedation Nutrition

31. Surgical management Surgical decompression Done if GCS decreases by 2 or more points between the point of injury and hospital evaluation The patient presents with fixed and dilated pupils The intra cranial pressure (ICP) exceeds 20mmHg

32. T ypes 1) Burr-hole It’s the opening into the cranium with a drill 2) Craniotomy Bone flap is temporarily removed from the skull to access the brain

33. 3 . Craniectomy Excision into the cranium to cut away a bone flap. 4 ) Cranioplasty Surgical repair of a defect or deformity of a skull

34. Nursing management Nursing assessment ABC GCS Neurologic examination Signs of Elevated ICP Signs of CSF leakage

35. Nursing diagnosis Infective tissue perfusion (cerebral) RT interruption of CBF associated with cerebral hemorrhage and edema Acute pain (headache) RT trauma and cerebral edema Hyperthermia related to increased metabolism AEB thermometer reading of above 37.5 degrees

36. Nursing diagnosis cont . Impaired physical mobility RT decreased LOC and treatment imposed bed rest Anxiety RT abrupt change in health status , hospital environment Risk for complications RT cerebral edema and hemorrhage

37. Preventive measures Health promotion. Prevent car and motor accidents. To ware safety helmets.

38. Complications Coma Chronic headaches Paralysis Seizures Speech and language problems