HEAD INJURY

BY: Engie Lee Cocamas

HEAD INJURY
is any trauma that leads to injury of the scalp, skull, or brain. The injuries can range from a minor bump on the skull to serious brain injury.

INCIDENCE: 90 % of nervous system trauma Most common among males Peak occurrence- evening, nights weekends

CAUSE: Accidents- motor vehicles, industrial Falls- abuse Blows- sports injuries, crime related injuries Construction occupational hazards

MECHANISM OF INJURY THAT CONTRIBUTED TO HEAD TRAUMA:

1. Acceleration- occurs when the immobile head is struck by a moving object.

2.Deceleration- moving head hits an immobile object. Example: head hit the steering wheel 3. Deformation- injuries in which the force results in deformation and disruption of the injury of the impacted body part (skull fracture)

Category of head trauma: 1. closed- the head sustain a blunt force by striking against an object
2. Penetrating trauma- an objects breaks through the skull and enters the brain

3. Coup and countercoup injuries- the impact to the head can cause the brain to move within the skull ,causing the brain to impact the interior of the skull opposite the head-impact)

Types of Primary Injury:

1.

Scalp injuries- Isolated scalp trauma is

generally classified as a minor injury. Because its many blood vessels constrict poorly , the blood bleeds profusely when injured.

2.Skull fractures-is a break in one or more of the bones in the skull caused by a head injury. It may occur with or without damage of the brain. Skull Fractures are classified as: >Simple >Comminuted >Depressed >Basilar

3.Brain injury: 1.Open head injuries-means you

were hit with an object that broke the skull and entered the brain.

2.Closed-blunt trauma- means

you received a hard blow to the head from striking an object, but the object did not break the skull.

3.Concussion- result in loss of consciousness

for 5 min or less and retrograde amnesia , no break in the skull or dura and no visible damage

4.Contusion- cause more extensive damage , petechial and punctuate hemorrhage and bruised areas

5.Diffuse axonal injury- one of the most common and devastating types of traumatic brain injury, meaning that damage occurs over a more widespread area than in focal brain injury.

.The major cause of damage in DAI is the disruption of axons, the neural processes that allow one neuron to communicate with another. Types: Mild- loss of consciousness 6-24 hours Moderate- coma less than 24 hours, on complete recovery and awakening Severe- primary injury to brain stem

DIAGNOSTIC TEST: Radiologic Examination Physical Examination and Evaluation of Neurologic Status CT scan

MRI ( Magnetic Resonance Imaging)

Cerebral Angiography

Neurosurgery
Possible reasons for neurosurgery include: 1. haemorrhage (severe bleeding) inside your head, which puts pressure on the brain and may result in brain injury (brain damage) and, in severe cases, death 2. haematoma (blood clot) inside your head, which can also put pressure on the brain 3.cerebral contusions (bruises on the brain), which can develop into blood clots 4.skull fracture

craniotomy

Medications: 1.Anti-epileptic drugs Some people do suffer from seizures after brain injury. Often these occur only in the early stages of your recovery but they can be a permanent consequence of your brain injury. Such as Carbamazepine.

2.Antidepressants It is very common for people to experience symptoms of depression following a brain injury. Citalopram, Paroxetine, Fluoxetine
3.Diuretics are used to decrease the amount of water in the patient's body. This makes less water available to the brain for swelling. Mannitol

Clinical Manifestations: Loss of consciousness, confusion, Bradycardia, bradypnea, hypotension Convulsions Fracture in the skull or face- Fluid drainage from nose, mouth or ears Stiff neck or vomiting Pupil changes

Severe headache Irritability, personality changes, or unusual behavior Restless, clumsiness, or lack of coordination Slurred speech or blurred vision Inability to move one or more of your limbs

Get medical help immediately if the person: Becomes unusually drowsy Behaves abnormally Develops a severe headache or stiff neck Loses consciousness, even briefly Vomits more than once

HEAD INJURY PREVENTION

Safety equipments during activities Obey traffic signals Be visible. Use age appropriate car seats for babies Make sure children have safe area to play Supervise children of any age DO NOT DRINK and DRIVE

DO NOT Do NOT wash a head wound bleeding a lot. Do NOT remove any object sticking out of a wound. Do NOT move the person unless needed. Do NOT shake the person if he or she seems dazed. Do NOT remove a helmet Do NOT pick up a fallen child with any sign of head injury. Do NOT drink alcohol within 48 hours of a serious head injury.

Nursing care: 1. Maintain airway *logroll patient onto his side to prevent aspiration *place support under pt.s head to keep his cervical spine straight 2. Check for presence of shock *elevate extremities 3.Check for evidence of Spinal Injury *do not move newly injured until proven there has no injury

4. Observe for scalp and skull injuries *cover open hand with cleanest material as possible *apply pressure to bleeding scalp only if there is no underlying fracture *dont attempt to remove foreign objects 5. Prevent infection *antibiotics/tetanus infections *never attempt to clean ears or nose

7. Observe for CSF leakages *CSF rhinorrhea- drainage from nose due to fracture of ethmoid bone *CSF otorrhea- drainage from ears due to fractureof temporal lobe Management: Place loose, sterile cotton buds at the opening of ear or nose to absorb the discharge. Instruct not to cough, sneeze or blow the nose dont use nasal section due to proximity of cerebrum and nasopharynx 8. Improve cognitive functioning