Head Injury

Head Injury Any trauma to the scalp, skull, or brain Head trauma includes an alteration in consciousness no matter how brief

Head Injury Causes Motor vehicle accidents Firearm-related injuries Falls Assaults Sports-related injuries Recreational accidents

Head Injury 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

Head Injury Types of Head Injuries Scalp lacerations The most minor type of head trauma Scalp is highly vascular  profuse bleeding Major complication is infection

Head Injury Types of Head Injuries Skull fractures Linear or depressed Simple, comminuted, or compound Closed or open Direct & Indirect Coup & Contrecoup

Head Injury Types of Head Injuries Skull fractures Location of fracture alters the presentation of the manifestations Facial paralysis Conjugate deviation of gaze Battle’s sign

Head Injury Types of Head Injuries 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

Battle’s Sign Fig. 55-13

Nursing Care of Skull Fractures Minimize CSF leak Bed flat Never suction orally; never insert NG tube; never use Q-Tips in nose/ears; caution patient not to blow nose Place sterile gauze/cotton ball around area Verify CSK leak: DEXTROSTIX: positive for glucose Monitor closely: Respiratory status+++

Head Injury Types of Head Injuries 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

Head Injury Types of Head Injuries Minor head trauma Postconcussion syndrome 2 weeks to 2 months Persistent headache Lethargy Personality and behavior changes

Head Injury Types of Head Injuries Major head trauma Includes cerebral contusions and lacerations Both injuries represent severe trauma to the brain

Head Injury Types of Head Injuries 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

Head Injury Pathophysiology Diffuse axonal injury (DAI) Widespread axonal damage occurring after a mild, moderate, or severe TBI Process takes approximately 12-24 hours

Head Injury Pathophysiology Diffuse axonal injury (DAI) Clinical signs:  LOC  ICP Decerebration or decortication Global cerebral edema

Head Injury Complications Epidural hematoma Results from bleeding between the dura and the inner surface of the skull A neurologic emergency Venous or arterial origin

Head Injury Complications Subdural hematoma Occurs from bleeding between the dura mater and arachnoid layer of the meningeal covering of the brain

Epidural and Subdural Hematomas Epidural Hematoma Subdural Hematoma Fig. 55-15

Head Injury Complications 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

Head Injury Complications 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

Head Injury Complications Subdural hematoma Subacute subdural hematoma Occurs within 2-14 days of the injury Failure to regain consciousness may be an indicator

Head Injury Complications Subdural hematoma Chronic subdural hematoma Develops over weeks or months after a seemingly minor head injury

Head Injury Diagnostic Studies and Collaborative Care 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

Head Injury Nursing Management Nursing Assessment GCS score Neurologic status Presence of CSF leak

Head Injury Nursing Management Nursing Diagnoses Ineffective tissue perfusion Hyperthermia Acute pain Anxiety Impaired physical mobility

Head Injury Nursing Management Planning Overall goals: Maintain adequate cerebral perfusion Remain normothermic Be free from pain, discomfort, and infection Attain maximal cognitive, motor, and sensory function

Head Injury Nursing Management Nursing implementation Health Promotion Prevent car and motorcycle accidents Wear safety helmets

Head Injury Nursing Management Nursing implementation Acute Intervention Maintain cerebral perfusion and prevent secondary cerebral ischemia Monitor for changes in neurologic status

Head Injury Nursing Management Nursing implementation Ambulatory and Home Care Nutrition Bowel and bladder management Spasticity Dysphagia Seizure disorders Family participation and education

Head Injury Nursing Management Evaluation Expected Outcomes Maintain normal cerebral perfusion pressure Achieve maximal cognitive, motor, and sensory function Experience no infection, hyperthermia, or pain