Head Trauma

Head Injuries:
Account for about one half of all trauma
deaths
Survivors range from baseline function to
severe morbidity
Even minor head injury can have severe
impact
As with most trauma, broken down into blunt
and penetrating

Anatomy of Nervous System
The nervous system is composed of
Brain
Spinal cord
The nervous system is divided into:
Central nervous system (Brain & Spinal Cord)
Peripheral nervous system

Physiology of Nervous System
Cerebral Blood Flow (CBF)
Main Arterial Pressure (MAP)
Intracranial Pressure (ICP)
Cerebral Perfusion Pressure (CPP)
CPP = MAP ICP
Injuries to the Brain & Skull
Scalp injuries
Skull injuries
Brain injuries
Scalp Injuries
Scalp has many blood vessels so injury may
bleed profusely.
Control bleeding with direct pressure.
Dont apply pressure when there is possible
skull injury.
Skull injuries
It include fractures to
the cranium and the
face, can be associated
with brain injury.
It is divided into:
Open skull fracture:
cranium is fractures and
scalp is lacerated.
Closed skull fracture:
scalp is lacerated but
cranium is intact.
Basal skull fracture

S & S of Skull Fractures and Brain Injuries
Visible bone fragments
Altered mental status
Deep lacerated or severe bruise
or hematoma
Depression or deformity of the
skull
Severe pain at site of injury
Battles Sign
Unequal or unreative pupils
Raccoons eye
Sunken eye
Bleeding from the ears and/or
nose
Clear fluid flow from ears and/or
nose
Personality change
Increased blood pressure, decreased
pulse rate and widening pulse pressure
(Cushings Syndrome)
Irregular breathing pattern
Temperature increase
Blurred or multiple vision
Impaired hearing or ringing
Equilibrium problems
Forceful or projectile vomiting
Posturing
Paralysis or disability on one side of the
body
Seizures
Deteriorating vital signs
Brain Injuries
Primary (Direct) Brain Injuries
Secondary (Indirect) Injuries
Primary Brain Injuries
It occur at the time of original insult
Direct damage done to brain parenchyma and
associated with vascular injuries
Brain tissue can be lacerated, punctured or
bruised by broken bones or foreign bodies
Damage is already done
Irreversible
Damage control (debridement)
Secondary Brain Injury
Damage that occurs after the initial insult
(ongoing injury processes)
Expanding mass lesions, swelling or bleeding
quickly overwhelm buffers
End result is increased intracranial pressure
(ICP) and/or herniation
Diagnosis and treatments target minimizing
the effects of these indirect insults
Secondary Injury Mechanisms
Mass effect and subsequent elevated ICP and
mechanical shifting leading to herniation
Hypoxia
Hypotension and inadequate CBF
Cellular mechanisms
Intracranial Causes
Herniation: displaced brain parenchyma
Damage to brain from trauma against the dura
itself as well as producing ischemia as well
Cerebral Edema: intracellular fluid collection
within neurons and interstitial spaces.
Intracerebral Hematomas
Brain Injuries Brain Concussion
Usually caused by blunt injuries.
Injuries patient shows transient alteration in
neurologic function
Mild injury usually with no detectable brain
damage.
May have brief loss of consciousness.
Headache grogginess and short memory loss
are common.
Brain Injuries Brain Contusion
A bruised brain or contusion can occur with
closed head injuries.
Usually caused by blow that causes the brain
to hit inside the skull
Unconsciousness or decreased level of
consciousness can occur
Brain Injuries A hematoma
Is a collection of blood within tissue.
Hematoma inside the cranium is named
according to its location:
Subdural hematoma: blood collection between
brain and dura
Epidural hematoma: blood collection between
dura and the skull
Subarachnoid Hemorrhage:
Intracerebral hematoma: blood collection within
the brain
Epidural Hematomas
Blood between
inner table of the
skull and the dura
Lens shaped
hematomas that do
not cross suture
lines on CT
Subdural Hematomas
Blood beneath the
dura, overlying the
brain and arachnoid,
resulting from tears to
bridging vessels
Crescent shaped
density that may run
length of skull
Very common in the
elderly
Subarachnoid Hemorrhage
Bleeding beneath the
arachnoid membrane
on the surface of the
brain.

Intracranial Hematoma
Focal areas of
hemorrhage
within the
parenchyma
ER Care of Skull Fractures and Brain Injuries
Take appropriate body
substance isolation
precautions.
Assume spine injury
Monitor conscious patient
for changes in breathing
Apply rigid collar,
immobilize the neck and
spine
Administer high
concentration oxygen by
NRM
Control bleeding
Keep patient at rest
Talk to conscious patient
(emotional support)
Dress and bandage open
wounds
Mange the patient for
shock
Be prepared for vomiting
Transport patient promptly
Monitor vital signs every
five minutes