1. Treat a Casualty with a Closed Head Injury

2. Combat Trauma Treatment 2Head Injury Introduction Most common for individuals working in hazardous environments Delicate structures demand diligence in the care of injured and damaged sensory organs Underlying structures may also be damaged –Cranium –Brain –Trachea –Neck vessels –Cervical spine

3. Combat Trauma Treatment 3Head Injury Anatomy and Physiology of the Head Scalp Skull (cranium) Brain

4. Combat Trauma Treatment 4Head Injury Anatomy and Physiology of the Head

5. Combat Trauma Treatment 5Head Injury Initial Assessment General Impression Assess Airway Assess Breathing Assess circulation

6. Combat Trauma Treatment 6Head Injury Rapid Trauma Assessment Look for obvious deformities –Depressed Skull Fractures –Lacerations –All head injuries must be treated as if cervical spine involvement Bleeding from ears and nose –Clear fluid from ears and nose –Swelling/discoloration behind ears –Swelling/discoloration around both eyes Assess pupils

7. Combat Trauma Treatment 7Head Injury Open Head Wound

8. Combat Trauma Treatment 8Head Injury Can the patient feel you touching his fingers and toes?

9. Combat Trauma Treatment 9Head Injury Neurological Exam Assess Neurologic status using the Glascow Coma Scale (GCS) –Severe head injury: GCS is < 9 –Moderate head injury: GCS is 9 to 12 –Minor head injury: GCS is 13 to 15

10. Combat Trauma Treatment 10Head Injury Glasgow Coma Scale

11. Combat Trauma Treatment 11Head Injury Glasgow Coma Scale

12. Combat Trauma Treatment 12Head Injury Nasal Injuries Signs and symptoms Special considerations Abrasions, lacerations, and punctures Avulsion Fully avulsed flaps of skin Septum Devaited

13. Combat Trauma Treatment 13Head Injury Nasal Injuries

14. Combat Trauma Treatment 14Head Injury Nasal Injuries Foreign objects Fully immobilize the spine Monitor vital signs, airway, and LOC Transport in a sitting position

15. Combat Trauma Treatment 15Head Injury Nasal Injuries Nosebleeds (epistaxis) –No signs or symptoms of skull fracture or spinal injury –Conscious patient, place in a slightly forward, seated position to allow for drainage. –Unconscious patient or if signs and symptoms of spinal injury are present, place on long spine board in recovery position.

16. Combat Trauma Treatment 16Head Injury Nasal Injuries

17. Combat Trauma Treatment 17Head Injury Oral Cavity Injuries Signs and symptoms –Lacerated lip or gum –Lacerated or avulsed tongue –Dislodged teeth

18. Combat Trauma Treatment 18Head Injury Airway Obstruction

19. Combat Trauma Treatment 19Head Injury Lacerated or Avulsed Tongue

20. Combat Trauma Treatment 20Head Injury Head Injuries Scalp wounds Skull injuries –Linear nondisplaced fractures, compound fractures, or depressed fractures –Large contusion or darkened swelling of scalp –Brain Injury

21. Combat Trauma Treatment 21Head Injury Concussion Implication that there is no significant injury to the brain –Trauma to the head with a variable period of unconsciousness or confusion and then a return to normal consciousness

22. Combat Trauma Treatment 22Head Injury Concussion

23. Combat Trauma Treatment 23Head Injury Cerebral Contusion Bruised brain tissue History of prolonged unconsciousness or serious alteration in state of consciousness Brain swelling may be severe and rapid Question CVA Personality Changes Altered LOC

24. Combat Trauma Treatment 24Head Injury Side of Impact Contusion

25. Combat Trauma Treatment 25Head Injury Intracranial Hemorrhage Three major types –Epidural hematoma –Subdural hematoma –Intracranial hematoma Signs and symptoms –Change in level of consciousness –headache –Decreased pulse rate –Increased blood pressure –Change in pupil size and reaction

26. Combat Trauma Treatment 26Head Injury Treatment of Brain Injuries

27. Combat Trauma Treatment 27Head Injury Treatment of Brain Injuries Manage IV fluids, as indicated Assess for shock Apply a dressing/bandage being careful not to compromise the airway

28. Combat Trauma Treatment 28Head Injury Treatment of Brain Injuries If brain tissue is exposed, apply a sterile dressing. Local protocol dictates moist or dry sterile dressing. Administer high flow Oxygen Reassess neurologic status and vitals Stabilize impaled object Support with suction of secretions as needed if available Administer wound care

29. Combat Trauma Treatment 29Head Injury Treatment of Brain Injuries Administer pain control as needed Full spinal immobilization Transport in head raised position by elevating the top of the litter or spinal board. Raise head of bed 30 degrees

30. Combat Trauma Treatment 30Head Injury Summary Anatomy of the head and central nervous system Rapid assessment Treatment of decreased level of consciousness Rapid Transport Frequent reassessment