head trauma part 1.powerpoint presentation

head trauma part 1 presentation

1. Head Trauma and its Management PRESENTED BY – DR MANDAR JAIN PG 1 EMERGENCY MEDICINE RKDF MEDICAL COLLEGE -

2. Head Injury Traumatic brain injury (TBI) is defined as brain function impairment that results from external force. “ SIGNATURE INJURY ” Presenting from confusion to coma , disability to death. Classified As - Mild TBI ( GCS 14 - 15 ) Moderate TBI (GCS 9 - 13 )- < 20% Mortality Severe TBI (GCS 3 - 8 )- around 40 % Mortality

3. Head Injury Causes Motor vehicle accidents ( leading cause among young and children) Falls ( leading cause among elderly ) Assaults Sports-related injuries Firearm-related injuries

4. Head Injury ( pathophysiology ) High potential for poor outcome. MAP= SBP + (SBP- DBP/3) CPP = MAP – ICP maintain MAP >80 mm Hg ICP – Adults – 10 – 15 mm Hg - Children – 3 -7 mm Hg - Infants – 1.5 – 6 mm Hg CUSHING REFLEX

5. Pathophysiology Primary brain injuries Secondary brain injuries – cellular and sub cellular events Brain edema – Intracellular and extra cellular Brain herniation –

6. Cerebral Herniation Supratentorial herniation Uncal Central ( transtentorial ) Cingulate ( subfalcine ) Transcalvarial Infratentorial herniation 5. Upward (upward cerebellar or  upward   transtentorial ) 6. Tonsillar (downward cerebellar )

7. Specific Head Injuries TYPES: 1. Scalp laceration 2. Skull Fractures 3. Minor Head Trauma Concussion and post-concussion syndrome 4. Major Head Trauma: Cerebral contusion Laceration and Hemorrhages

8. Specific Head Injuries 1. Scalp lacerations The most minor type of head trauma Scalp is highly vascular  profuse bleeding Major complication is infection

9. Specific Head Injuries 2. Skull fractures Linear Skull Fracture Depressed Skull Fracture Diastatic Skull Fracture Basal Skull Fracture Compound Skull # (open) and closed # Comminuted fracture Compound elevated Skull Fracture Growing Skull Fracture Coup & Countre coup

10. Specific Head Injuries Skull fractures Location of fracture alters the presentation of the manifestations Basillar skull fractures – Battle’s sign, Raccoon eyes CSF leak Hemotympanum Decreased hearing or deafness and 7 th CN palsy

11. Battle’s Sign and Raccoon eyes Fig. 55-13

12. Specific Head Injury Basilar Skull fractures CSF leak (extravasations) into ear ( Otorrhea ) or nose ( Rhinorrhea ) High risk infection or meningitis “HALO Sign ” on clothes of linen Possible injury to Internal carotid artery Permanent CSF leaks possible

13. Investigations X-ray CT scan: standard modality MRI Bleeding from the ear or nose in cases of suspected CSF leak - "halo" or "ring" sign , when dabbed on a tissue paper CSF leak - analyzing the glucose level and by measuring tau- transferrin .

14. Management Pre-hospital care: Patients with severe head injuries should be assumed to have a cervical spine (C-spine) injury and immobilized with until clinical and radiographic studies can prove otherwise Minimize CSF leak Elevate Head of the pateint Bed Never suction orally; never insert NG tube; never use Q-Tips in nose/ears; caution patient not to blow nose Place sterile gauze/cotton ball around area Definitive Rx: Measures to reduce ICP Supportive management Surgery

15. Specific Head Injury 3. Minor head trauma Concussion : head injury with a temporary loss of brain function concussion can cause a variety of physical, cognitive , and emotional symptoms. - Cause : Sudden acceleration and deceleration injury eg : Car accident, sports injury, bicycle accident etc

16. Specific Head injuries Concussion Presentation: Physical-headache, LOC, Amnesia, s/s of  ICP(Cushing’s triad) , convulsions Cognitive : confusion, irritability, behavioral changes

17. Specific Head Injuries Minor head trauma Post concussion syndrome 2 weeks to 2 months Persistent headache Lethargy Personality and behavior changes

18. Specific Head Injuries 4. Major head trauma Includes cerebral contusions and lacerations Both injuries represent severe trauma to the brain

19. Specific Head Injuries Major head trauma Contusion The bruising of brain tissue within a focal area that maintains the integrity of the pia mater and arachnoid layers associated with multiple micro-hemorrhages, small vessel bleed into brain tissue Lacerations Involve actual tearing of the brain tissue Intracerebral hemorrhage is generally associated with cerebral laceration

20. Head Injury Cerebral Contusion Cerebral Laceration

21. Specific Head Injuries Diffuse axonal injury (DAI) Widespread axonal damage occurring after a mild, moderate, or severe TBI Seen in half the cases of head injury Process takes approximately 12-24 hours

22. Specific Head Injuries Diffuse axonal injury (DAI) Clinical signs:  Level of Consciousness  ICP Decerebration or decortication Global cerebral edema 90% regain consciousness from severe DAI

23. Thank you