Head Trauma

Head TraumaHead Trauma

Head Trauma Facts:Head Trauma Facts:

• 40% of multiple trauma victims have brain injuries.

• Brain injured patients have a death rate twice that of non-brain injured patients.

• Head injuries account for 25% of all trauma deaths and 50% of motor vehicle fatalities.

The SkullThe Skull

Brain InjuryBrain Injury

• Most brain injuries are not from direct injury to the brain.

• Most occur as a result of external forces against the skull or from movement of the brain inside the skull.

Deceleration InjuriesDeceleration Injuries

• The head strikes an object causing a sudden deceleration of the skull. The brain continues to travel forward and impacts the front of the skull.

• The brain then rebounds and strikes the rear of the skull.

Coup / CountercoupCoup / Countercoup

• Coup is the original impact.

• Countercoup is the rebound impact.

COUP CONTRECOUP

Skull FracturesSkull Fractures

Brain InjuriesBrain Injuries

• Concussion

• Cerebral Contusion

• Intracranial Hemorrhage– ( bleeding inside the skull)

Intracranial PressureIntracranial Pressure

• Injury to the brain can cause bleeding around the brain and/or swelling of the brain tissue.

• The brain cannot expand inside the skull, therefore pressure increases inside the skull - INTRACRANIAL

As ICP Increases:As ICP Increases:

• Cerebral perfusion pressure =mean arterial pressure - ICP

• As ICP increases, the blood pressure increases in an attempt to maintain Cerebral Perfusion Pressure - Cushing Reflex

Vital SignsVital Signs

Blood Pressure

Pulse

Respiration

Assessment of the PatientAssessment of the Patient

• All patients with head or facial trauma have a cervical spine injury until proven otherwise!!

• Because head injured patients are often combative or have a decreased level of consciousness, a thorough assessment must be completed.

Don’t Be Trapped?Don’t Be Trapped?

• Head injured patients are often under the influence of drugs and/or alcohol. Don’t let this influence your assessment and cause you to miss important information.

AlsoAlso

• Head injured patients are also often uncooperative and/or aggressive even when not under the influence.

• Be patient and understanding! Resist making personal judgements about your patient.

Signs and SymptomsSigns and Symptoms

• Mechanism of Injury

• Decreased level of Consciousness

• Bleeding or Fluid from Ears / Nose

• Watch the Vital Signs -Trend over Time

Signs & Symptoms (cont)Signs & Symptoms (cont)

• Projectile Vomiting• Seizures• Unequal Pupils (late)• Hemiparesis - weakness or paralysis on one side of

the body• Posturing

ManagementManagement

• C-Spine Immobilization• Airway management

– have suction available• High concentration oxygen or ventilate 12/min • Manage bleeding from scalp lacerations

– do not attempt to stop bleeding from

ears / nose

Management (cont)Management (cont)

• Be prepared for seizures.

• If patient is on a backboard with C-Spine immobilization you can raise the head of the board slightly (4-6 inches) to possibly lower ICP.