Head Injury in children and its prevention.pptx

head injury

1. Head injuries in children

2. The skull bones

3. Layers of skull

4. introduction 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. Is a pathologic process involving the scalp, skull, meninges or brain as a result of mechanical force. It 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. incidence Falls Motor vehicle injuries. Bicycle injuries Motor vehicle accidents Assaults Sports related injuries Firearm related injuries Act of violence 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. Childrens are not young adults Their heads are proportionally bigger to the rest of their bodies than adults, this means it more likely to get injured in a trauma. The subarachnoid space in thinner, meaning there is less “cushioning” during any impact. The cranial sutures don’t fully close until 12-18 months, so in young children there’s an increased tolerance for expanding intracranial contents (e.g. haematomas , oedema), which can go unrecognized. Check the fontanelles in all young children presenting with a head injury.

7. Childrens are not young adults The unfused cranial sutures also mean a large volume of blood can collect intracranially, leading to hypovolaemic shock. Young children can have up to twice the cerebral blood flow of an adult, making them more susceptible to secondary brain injury, particularly due to hypoxia. Children are more likely to vomit following a head injury, regardless of their intracranial pressure.

8. Types of head injuries Concussion. Contusion. Laceration. Hematomas 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 fibers, particularly in the area of the brain stem.

10. Coup-countercoup injury

11. Coup-countercoup injury

12. contusion Represents petechial hemorrhages or localized bruising 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 contusion are occipital, frontal and temporal lobes. It may cause focal disturbances in strength , sensations or visual awareness in children.

13. 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.

14. hematomas Hematoma means localized collection of blood outside the blood vessel May be associated or not with the internal injury Blood deposited in the subcutaneous tissue

15. 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 Linear: Most common simple type, typically in the temporal or parietal area Comminuted: broken bone displace inward Depressed.: Depression palpated and seen in x-ray Open: the skin is broken along with skull Basilar: when fracture involve base of skull Growing fractures: herniation of brain from broken dura following skull fracture,

16. Sign and symptoms CSF or other fluids draining from the ear or nose Blood behind the tympanic membrane Battle’s sign Vision changes & damage of optic nerve Hearing loss Loss of sense of smell Loss of eye movement Nystagmus Loss of consciousness amnesia Headache Vomiting Seizures Unilateral facial paresis Vertigo

17. 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 Linear: Most common simple type, typically in the temporal or parietal area Comminuted: broken bone displace inward Depressed.: Depression palpated and seen in x-ray Open: the skin is broken along with skull Basilar: when fracture involve base of skull Growing fractures: herniation of brain from broken dura following skull fracture,

18. complications Seizures. Venous sinus thrombosis. Intra-cerebral bleed. Meningitis (if there is an open fracture). Hemorrhage . Infection. Edema. Herniation.

19. Signs and symptoms

20. Diagnostic investigation History collection and physical examination Complete blood count CT SCAN MRI Electroencephalography (EEG) X-RAY

21. Glasgow Coma Scale (GCS) Eye opening:   -Spontaneous 4 -To verbal stimuli 3 -To pain 2 -None 1 Best motor response (if pre-verbal, use best grimace response): -Spontaneous / obeys command 6 -Localises to pain or withdraws to touch 5 -Withdraws from pain 4 -Abnormal flexion to pain (decorticate) 3 -Abnormal extension to pain (decerebrate) 2 -No response 1

22. Glasgow Coma Scale (GCS) Best verbal response:   -Alert, babbles and coos words to normal ability 5 -Less than usual words, spontaneously irritable cry 4 -Cries only to pain 3 -Moans to pain 2 -No response 1 For nonverbals (<4 years) Spontaneous normal facial or oromotor activity 5 Less than usual spontaneous activity or only responsive to touch 4 Vigorous grimace to pain 3 Mild grimace to pain 2 No response to pain 1

23. Medical Management INITIAL MANAGEMENT A: Airway control including cervical spine immobilization with a stiff collar. B: Breathing C: Circulation CONTROL OF INTRACRANIAL PRESSURE: Position head up 30º Diuretics: Furosemide, Mannitol Seizure control: Barbiturates CALCIUM CHANNEL BLOCKERS OXYGENATION

24. Management Rest Ice or cold compress on the area and analgesic for pain Antibiotic ointment and a bandage Stitches in the scalp to close a wound Being watched for a period of time for following physical symptoms Headache Vomiting Drowsiness or fatigue Fits/seizures/twitching/convulsion Blurred or double vision Arm or leg weakness

25. Arm or leg weakness Difficulties swallowing , or coughing when eating or drinking Sensitivity to noise, unusual or confused behaviour .

26. Surgical Management: craniotomy

27. Surgical Management: craniectomy

28. Surgical Management: cranioplasty

29. Nursing diagnosis Ineffective tissue perfusion (cerebral) Acute pain (headache) related to trauma and cerebral edema Hyperthermia related to loss of cerebral integrative function secondary to possible hypothalamus injury Impaired physical mobility related to decreased LOC and treatment –imposed bed rest Fluid volume deficit related to decrease LOC and hormonal dysfunction. Risk for injury related to decreased level of consciousness. Knowledge deficit regarding the treatment modalities and current situation. Anxiety related to abrupt change in health status, hospital environment and uncertain future

30. Nursing management Continuous monitoring of vital signs 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.