5 - Head injuries for nurses in emergency room

This course is designed for Intermediate EMT students in the field of pre hospital setting

1. Head injuries

3. I -Scalp injuries(stretched skin)
II –Skull.
III-Meninges .
IV-Brain

5. Infection is dangerous
why???
Cut and contused wounds in the scalp
What is the problem?

6. II -SKULL INJURIES
Factors governing fractures of the skull:
1-Force
2-Striking surface area( hammer –chair)
3-Position of the head(supported or not)
4-Site of the blow:
The weakest points are the squamous and
temporal bones

7. Types of skull fractures: -
1-Skull fractures due to blunt instruments.
Fissure –depressed –comminuted
2-Skull fractures due to sharp instruments
chipped -cut -cut comminuted

8. 1-Fissure fracture (linear fracture)
-Blunt instrument with wide sticking SA and
low momentum.
It starts at the point of impact.
It extends parallel to the line of force.
The fissure may run into sutures
Multiple blows may produce multiple
fissures, but a second fissure will end
when it reaches the first fissure
Fissure fractures may be alone or they may
accompany other types of fractures.

10. Types of Fissure
Fracture.
Polar fracture:
Ring fracture
Thermal fracture

11. 2-Depressed fracture
Caused by blunt instrument with small
surface area and medium force
Depressed localized fractures:
It takes the shape of striking surface
Usually small in size
May be accompanied with fissure fracture

14. 3-Depressed comminuted fracture:
heavy blunt object having a wide
Surface area and high momentum
car accidents,
fall from height.

17. Dangers of depressed fractures : -
1-Cerebral laceration
2-Intra cranial hemorrhage.
3-Cerebral compression.
4-Intracranial infection.
5-Subjecting the patients to a
decompression operation, this leaves
a bony gap and permanent infirmity.

19. 2-Skull fractures due to sharp instruments
A-Sharp and light instrumente.g. knife
Cut fracture
Chipped F tangentially causing removal
of the outer table.
B-Sharp and heavy instruments

20. Injuries produced by an axe
1-The blade of an axe cut fracture.
2-If the blade passes tangential to the outer table;
chipped F
3-The cut may be triangular if the striking is done
with angle
4-The striking with the head of the axe
localized DF.
5-The handle of the axe fissure fractures.

22. FRACTURES OF THE BASE
These are usually fissure fractures
Fracture Anterior fossa eye
Fracture Middle fossaear
Fracture posterior fossaneck

23. HEALING OF SKULL FRACTURES
A-Healing of fissure fracture
1.The edges are glued by serous exudates in one week
2.Smoothening of the edges in about 2-3 weeks
3.Complete closure with osseous in 3-4 months
B-Healing of depressed / comminuted
fracture (no bone)
C-Healing of cut fractures. As those of
fissure fractures

24. Sepsis
Appears in the skull in the form of bone
erosion affecting either the outer, inner or
both tables within 4-6 weeks. Bone erosion
indicates that the cause of death is possibly
septic intracranial complications -
meningitis, brain abscess or sinus
thrombosis

25. III-INJURIES TO MENINGES
1-Extradural hemorrhage (Traumatic)
2-Subdural hemorrhage
* Traumatic → A-acute
B-Chronic(pachymeningitis haemorrhagica)
* Pathological (hypertension-Blood Disease ---)
3-Subarachnoid hemorrhage:
4-Intracerebral hemorrhage:
A-Traumatic: Coupinjuryor Contre-coup
B-Pathological

27. IV-BRAIN INJURIES
A-CONCUSSION :
* Definition
* C/P
* Fate of concussion
1-Complete uncomplicated recovery
2-Death
3-Compression

28. Lucid interval
Definition:
Mechanism :
Medico legal importance
Treatment of concussion :
observation. No morphine

29. B-COMPRESSION
Definition
Mechanism Stage of irritationStage of paralysis
Clinical picture: Victim is conscious 
gradually drowsiness blurring of
vision severe headache (mainly
occipital). Then-Fevereffortless
centralvomiting High blood
pressureslow full pulse coma 
death

30. Causes of cerebral compression
1-Intracranial hemorrhage.
2-Pressure by fragments of bone
Treatment of compression

31. The following are lateralizing signs of
compression, which are diagnostic to the
compressed side:
On the side of hemorrhage
The pupils are unequal constricted(more on affected side)
Conjugate deviation of both eyes
On the opposite side
Exaggerated reflex of the other side
Hemiplegia occurs on the contra lateral side

33. C-brain contusion
d-brain laceration
Both contusion and laceration can occur in
cases of coup or contre-coup lesion.

34. Differences between concussion and
compression
Mechanism
Loss of consciousness
Pulse
BP
Reflexes
Vomiting
Pupils
Signs of lateralization
Treatment

35. SEQULLAE & COMPLICATIONS OF HI
1-Post traumatic amnesia or retrograde amnesia
2-Post traumatic automation
3-Post traumatic neurosis
4-Korsakoff's psychosis
5-Personality changes:
6-Jacksonian epilepsy
7-Septic complications
8-Permanent infirmity