1. Head Trauma 181 st INF BDE Combat Lifesaver Plus 181 st INF BDE Combat Lifesaver Plus

2. Overview Anatomy of head and brain Pathophysiology of traumatic injury Assessment, management, potential problems 1Head Trauma -

3. Head Trauma Traumatic brain injury (TBI) Major cause of death and disability Present in 40% of multiple trauma casualties 2Head Trauma -

4. Head Trauma Open Skull compromised and brain exposed Closed Skull not compromised and brain not exposed 3Head Trauma -

5. Head Injuries Scalp wound Highly vascular, bleeds briskly Shock: child may develop Shock: adult another cause Management No unstable fracture: direct pressure, dressings Unstable fracture: dressings, avoid direct pressure 4Head Trauma -

6. Skull fracture Linear nondisplaced Depressed Compound Suspect fracture Large contusion or darkened swelling Management Dressing, avoid excess pressure Head Injuries 5Head Trauma -

7. Basilar Skull Fracture Battle’s signRaccoon eyes 6Head Trauma -

8. Head Injuries Penetrating trauma 7Head Trauma - Bullet Fragments

9. Head Trauma -8 Forces that cause skull fracture can also cause brain injury.

10. Brain Injury Primary brain injury Immediate damage due to force Coup and contracoup Management Directed at prevention 9Head Trauma -

11. Brain Injury Secondary brain injury Results from hypoxia or decreased perfusion Develops over hours Management Rapid evacuation care can help prevent 10Head Trauma -

12. 11 Early efforts to maintain brain perfusion can be life-saving.

13. Brain Injuries Concussion No structural injury to brain Level of consciousness Variable period of unconsciousness or confusion Followed by return to normal consciousness Retrograde short-term amnesia May repeat questions over and over Associated symptoms Dizziness, headache, ringing in ears, and/or nausea 12Head Trauma -

14. 13 Decreased level of consciousness is an early indicator of brain injury or rising ICP

15. Head Trauma Assessment Casualty Evaluation Limit patient agitation, straining Contributes to elevated ICP Airway Vomiting very common within first hour 14Head Trauma -

16. Reactive: ICP increasing Nonreactive (altered LOC): increased ICP Nonreactive (normal LOC): not from head injury Pupils Both dilated Nonreactive: brainstem Reactive: often reversible Unilaterally dilated 15Head Trauma - Eyelid closure Slow: cranial nerve III Fluttering: often hysteria Anisocoria

17. Summary Early detection and rapid transport is essential Key actions Rapid assessment, airway management, prevent hypotension, frequent Ongoing Exams Altered mental status is common 16Head Trauma -

18. Discussion 17Head Trauma -