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Head injury

Head injury is a leading cause of death

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Head injury

  1. 1. Head InjuryHead Injury
  2. 2. Definition of head injury Discus the types of head injury Understand the different sign and symptom of head injury Describe the pathophysiol0gy of head injury Explain the diagnostic evaluation of head injury Enlist the complication of head injury Detail the management of head injury
  3. 3. Any trauma to the scalp, skull, or brain Head trauma includes an alteration in consciousness no matter how brief
  4. 4. Causes Motor vehicle accidents Firearm-related injuries Falls Assaults Sports-related injuries Recreational accidents
  5. 5. High potential for poor outcome Deaths occur at three points in time after injury: Immediately after the injury Within 2 hours after injury 3 weeks after injury
  6. 6. Scalp lacerations The most minor type of head trauma Scalp is highly vascular → profuse bleeding Major complication is infection
  7. 7. Types of Head Injuries Skull fractures Linear or depressed Simple, comminuted, or compound Closed or open Direct & Indirect Coup & Contrecoup
  8. 8. Skull fractures Location of fracture alters the presentation of the manifestations Facial paralysis Conjugate deviation of gaze palsy Battle’s sign
  9. 9. Basal Skull fractures CSF leak (extravasation) into ear (Otorrhea) or nose (Rhinorrhea) High risk infection or meningitis “HALO Sign (Battle Sign)” on clothes of linen Possible injury to Internal carotid artery Permanent CSF leaks possible
  10. 10. Fig. 55-13
  11. 11. Minor head trauma Concussion A sudden transient mechanical head injury with disruption of neural activity and a change in LOC Brief disruption in LOC Amnesia Headache Short duration
  12. 12. Minor head trauma Postconcussion syndrome 2 weeks to 2 months Persistent headache Lethargy Personality and behavior changes
  13. 13. Major head trauma Includes cerebral contusions and lacerations Both injuries represent severe trauma to the brain
  14. 14. Major head trauma Contusion The bruising of brain tissue within a focal area that maintains the integrity of the pia mater and arachnoid layers Lacerations Involve actual tearing of the brain tissue Intracerebral hemorrhage is generally associated with cerebral laceration
  15. 15. Diffuse axonal injury (DAI) Widespread axonal damage occurring after a mild, moderate, or severe TBI Process takes approximately 12-24 hours
  16. 16. Diffuse axonal injury (DAI) Clinical signs: ↓ LOC ↑ ICP Decerebration or decortication Global cerebral edema
  17. 17. Epidural hematoma Results from bleeding between the dura and the inner surface of the skull A neurologic emergency Venous or arterial origin
  18. 18. Subdural hematoma Occurs from bleeding between the dura mater and arachnoid layer of the meningeal covering of the brain
  19. 19. Fig. 55-15 Subdural Hematoma Epidural Hematoma
  20. 20. Subdural hematoma Usually venous in origin Much slower to develop into a mass large enough to produce symptoms May be caused by an arterial hemorrhage
  21. 21. Subdural hematoma Acute subdural hematoma High mortality Signs within 48 hours of the injury Associated with major trauma (Shearing Forces) Patient appears drowsy and confused Pupils dilate and become fixed
  22. 22. Subdural hematoma Subacute subdural hematoma Occurs within 2-14 days of the injury Failure to regain consciousness may be an indicator
  23. 23. Subdural hematoma Chronic subdural hematoma Develops over weeks or months after a seemingly minor head injury
  24. 24. CT scan considered the best diagnostic test to determine craniocerebral trauma MRI Cervical spine x-ray Glasgow Coma Scale (GCS) Craniotomy Craniectomy Cranioplasty Burr-hole
  25. 25. Nursing Assessment GCS score Neurologic status Presence of CSF leak
  26. 26. Nursing Diagnoses Ineffective tissue perfusion Hyperthermia Acute pain Anxiety Impaired physical mobility
  27. 27. Planning Overall goals: Maintain adequate cerebral perfusion Remain normothermic Be free from pain, discomfort, and infection Attain maximal cognitive, motor, and sensory function
  28. 28. Nursing implementation Health Promotion Prevent car and motorcycle accidents Wear safety helmets
  29. 29. Acute Intervention Maintain cerebral perfusion and prevent secondary cerebral ischemia Monitor for changes in neurologic status
  30. 30. Ambulatory and Home Care Nutrition Bowel and bladder management Spasticity Dysphagia Seizure disorders Family participation and education
  31. 31. Expected Outcomes Maintain normal cerebral perfusion pressure Achieve maximal cognitive, motor, and sensory function Experience no infection, hyperthermia, or pain
  32. 32.  McCaffrey RJ (1997). "Special Issues in the Evaluation of Mild  Traumatic Brain Injury". The Practice of Forensic Neuropsychology: Meeting Challenges in the Courtroom. New  York: Plenum Press. pp. 71–75. ISBN 0-306-45256-1. Jump up^ "What is Head Trauma?". News Medical.  Retrieved 2013-05-04. ^ Jump up to:a  b  "Head injury- first aid". MedlinePlus.  Retrieved 2013-05-04. Jump up^ "Head Injury (Brain Injury)". eMedicinehealth.  Retrieved 2013-05-04. Jump up^ name="Head Injury (Brain Injury)" Jump up^ Carlson, Neil R. (2013). "Physiology of Behavior". In  Campanella, Craig.Neurological Disorders. Pearson Education,  Inc. pp. 526–527. ISBN 0-205-23939-0.