HEAD TRAUMA

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HEAD TRAUMA
HEAD TRAUMA

• Instructor Name
• Title
• Unit

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OVERVIEW

• Anatomy of skull and brain
• Pathophysiology of head injury
• Review of specific head injuries
• Assessment of head trauma
• Management of head trauma

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HEAD INJURY

• Cause of death in 25 of trauma patients
• Cause of death in 50 of MVCs
• Significant long term disability
• Prompt recognition and treatment can improve
  outcome
• All patients with head or facial trauma have
  c-spine injury until proven otherwise

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ANATOMY
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BRAIN INJURY

• Brain injury results from
• Direct injury to brain tissue
• External forces applied to outside of skull
  transmitted to the brain
• Movement of brain inside skull

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COUP CONTRACOUP

• 4 collision concept
• Auto strikes tree
• Head strikes windshield
• Brain strikes inside of frontal skull
• Brain rebounds and hits inside of occipital skull

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PRIMARY vs. SECONDARY BRAIN INJURY

• Primary injury is immediate from bruising or
  penetrating objects
• Secondary injury is from hypoxia or ? perfusion
  of the brain
• Caused by swelling, hypoxia, or hypotension
• May be prevented by good patient care
• Hyperventilation decreases perfusion of the brain
  tissue
• Protect airway, give oxygen, maintain BP

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HEAD INJURIESSCALP WOUNDS

• Very vascular
• Bleed briskly
• Most scalp bleeding can be controlled with direct
  pressure

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HEAD INJURIESSKULL INJURIES
Courtesy Roy Alson, MD
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SIGNS OF BASILAR SKULL FRACTURE
Courtesy David Effron, M.D.
Courtesy David Effron, M.D.
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HEAD INJURIES BRAIN INJURIES

• Concussion
• Cerebral contusion
• Diffuse axonal injury
• Anoxic brain injury

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HEAD INJURIESEPIDURAL HEMATOMA
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HEAD INJURIES SUBDURAL HEMATOMA
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HEAD INJURIES INTRACRANIAL HEMORRHAGE
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ASSESSMENT RAPID TRAUMA SURVEY

• Note LOC (AVPU), secure airway and protect
  c-spine
• Assess breathing
• Do not allow the patient to become hypoxic
• Assess circulation
• Control major bleeding
• Prevent hypotension
• Transport decision and interventions
• Do brief neuro GCS if altered LOC

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ASSESSMENT DETAILED EXAM

• Vital signs
• SAMPLE history
• Head-to-toe exam, including neurological and GCS
• Further bandaging and splinting
• Continuous observation

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PUPILS
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POSTURING
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MANAGEMENT OF THE HEAD TRAUMA PATIENT

• Stabilize the c-spine
• Secure and maintain the airway
• Ventilate at about 15 breaths/min.
• Prevent hypoxia
• Hyperventilate only patients with the herniation
  syndrome
• Coma, ?BP, ?Respiration, bradycardia

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AIRWAY CONTROL CANNOT BE OVEREMPHASIZED
HEAD TRAUMA
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MANAGEMENT

• Record baseline exam
• Neuro, GCS pupils
• Vital signs
• Maintain good circulation
• BP 110-120 systolic
• Continually monitor and record observations
• Prompt transport

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PITFALLS PROBLEMS

• Anticipate c-spine injuries
• Protect the airway - prevent aspiration
• Prevent hypoxia
• Prevent shock
• IV fluids and PASG are OK

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PITFALLS PROBLEMS

• Be prepared for seizures
• Rapidly deteriorating condition requires rapid
  hospital treatment
• Assess for other causes of altered LOC
• Hypoglycemia
• Alcohol
• Drugs

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SUMMARY

• Follow patient assessment
• Protect c-spine, airway, and circulation
• Record frequent vital signs, neuro, pupils, and
  GCS
• Prompt transport

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QUESTIONS?