Head Trauma

• Head injuries


  Broad classification that encompasses any damage to the head as a result of trauma, does not necessarily mean a brain injury is present
• Traumatic Brain Injury (TBI)


  Craniocerebral edema, describes an injury that is a result of an external force and is of sufficient magnitude to interfere with daily life and prompts the seeking of treatment

  
• Causes of head injuries

  • Falls
  • Sports injury
  • Child abuse
  • Blast injuries due to explosions
  • Blast hit by a bullet/sharpel
  • Being hit by a weapon
• Primary injury


  • Consequence of direct contact to the brain/head during the instant of initial injury, causing extracranial focal injuries (contusion, lacerations, external hematomas, skull fractures)

  
• Secondary injury


  • Evolves over the ensuring hours and days after the initial injury and results from inadequate delivery of glucose and oxygen to the cells
• Types of head injuries

  • Open
  • Closed
• Open head injuries

  • Scalp lacerations - generally classified as minor injury
  • Fractures of the skull
• Closed head injuries


  Occur when the head accelerates and then rapidly decelerates or collides with another object
• Types of closed head injuries

  • Concussions
  • Contusions
  • Hematomas
• Scalp laceration


  Tearing of tissues, potential portals of entry for organisms that cause intracranial infection, irrigation of the area before suturing to remove foreign material and to reduce risk for infection
• Skull fracture


  Break in the continuity of the skull caused by forceful trauma, with or without damage to the brain, classified by type and location
• Types of skull fractures

  • Linear
  • Comminuted
  • Depressed
• Locations of skull fractures

  • Frontal
  • Temporal
  • Basal
• Signs of basal skull fracture

  Increase CSF, Battle's sign, Racoon's eye
• Beta Transferrin Test


  Laboratory test that confirms presence of CSF by the presence of protein
• Concussion


  Temporary loss of neurologic function with no apparent structural damage to the brain, caused by a blow to the head or violently shaking of the head, characterized by LOC associated with stupor and confusion
• Contusion


  Brain is bruised and damaged in a specific area because of severe acceleration-deceleration force or blunt trauma

  
• Hematomas


  Collection of blood in the brain that may be epidural (above the dura), subdural (below the dura), or intracerebral (within the brain)

  
• Epidural hematoma


  Symptoms like brief loss of consciousness, followed by a lucid interval in which the patient is awake and conversant
• Acute subdural hematoma


  Changes in level of consciousness, pupillary signs, and hemiparesis
• Intracerebral hematoma


  Development of neurological deficits followed by headache
• Classification of head injuries

  • Mild (GCS 13-15, LOC 0-15 minutes)
  • Moderate (GCS 9-12, LOC up to 6 hours)
  • Severe (GCS 3-8, LOC greater than 6 hours)
• Assessment of head injuries

  • Changing neurological signs, level of consciousness
  • Changes in airway and breathing patterns
  • Vital signs reflecting increased ICP (Increased temperature, Increased blood pressure, Decreased heart rate, Decreased respiratory rate)
  • Headache, nausea, vomiting
  • Visual disturbances, pupillary changes, papilledema
  • Weakness and paralysis, posturing
  • Decreased sensation, reflex activity changes

  
• Diagnostic evaluation


  • X Rays: Identify fracture and displacement
  • CT Scan: Identify and localize lesions, edema, bleeding
• Management of head injuries

  • Care of clients with increased ICP (bed rest, semi-fowlers position to promote healing, avoid exertion, activity and bending over)
  • Maintain adequate cerebral perfusion
  • Antibiotics: prevent infection with open skull fracture
  • Surgery: evacuation of intracranial hematoma, debridement of wound, elevation of fracture or repair of leaks
• Penetrating brain injuries


  Most severe form of traumatic brain injury, causes: being hit by a bullet, shrapnel, weapon (hammer, baseball bat, knife), symptoms: bleeding, difficulty of breathing, seizure, neurological dysfunctions (problems moving, loss of feeling in the limbs, loss of consciousness)

  
• Predisposing factors for headache

  • Stress
  • Anxiety
  • Depression
  • Not getting enough sleep
  • Missing meals
  • Triggered by chocolate, cheese, MSG
• Types of headache


  • Tension: bilateral pain, sensation of a band-like (back of the neck then over the top of the head)
  • Migraine: unilateral pain, severe, throbbing including the temporal area, aura (nausea, sweating, visual changes) preceding pain
  • Cluster: unilateral pain, intense, throbbing behind or around eye, lasting from 30-90 minutes

  
• Nursing interventions for headache

  • Quiet, dark environment
  • Increase fluid intake- drink liberal amounts of water
  • Cool cloth on the head
  • Relaxation techniques
  • Medications: Aspirin, Acetaminophens
• Medications for migraine


  • Beta Blockers (OLOL) Propanolol, Atenolol
  • Calcium Channel Blockers (DIPINE) Amlodipine
  • NSAIDS Ibuprofen, Naproxen