Instructor Name: Title: Unit: HEAD TRAUMA HEAD TRAUMA Instructor Name: Title: Unit: 1

OVERVIEW Anatomy of skull and brain Pathophysiology of head injury Review of specific head injuries Assessment of head trauma Management of head trauma

HEAD INJURY Cause of death in 25% of trauma patients Cause of death in 50% of MVCs Significant long term disability Prompt recognition and treatment can improve outcome All patients with head or facial trauma have c-spine injury until proven otherwise

ANATOMY

BRAIN INJURY Brain injury results from: Direct injury to brain tissue External forces applied to outside of skull transmitted to the brain Movement of brain inside skull

COUP CONTRACOUP “4 collision” concept Auto strikes tree Head strikes windshield Brain strikes inside of frontal skull Brain rebounds and hits inside of occipital skull

PRIMARY vs. SECONDARY BRAIN INJURY Primary injury is immediate from bruising or penetrating objects Secondary injury is from hypoxia or  perfusion of the brain Caused by swelling, hypoxia, or hypotension May be prevented by good patient care Hyperventilation decreases perfusion of the brain tissue Protect airway, give oxygen, maintain BP

HEAD INJURIES SCALP WOUNDS Very vascular Bleed briskly Most scalp bleeding can be controlled with direct pressure

HEAD INJURIES SKULL INJURIES Courtesy Roy Alson, MD

SIGNS OF BASILAR SKULL FRACTURE Courtesy David Effron, M.D. Courtesy David Effron, M.D.

HEAD INJURIES BRAIN INJURIES Concussion Cerebral contusion Diffuse axonal injury Anoxic brain injury

HEAD INJURIES EPIDURAL HEMATOMA

HEAD INJURIES SUBDURAL HEMATOMA

HEAD INJURIES INTRACRANIAL HEMORRHAGE

ASSESSMENT RAPID TRAUMA SURVEY Note LOC (AVPU), secure airway and protect c-spine Assess breathing Do not allow the patient to become hypoxic Assess circulation Control major bleeding Prevent hypotension Transport decision and interventions Do brief neuro & GCS if altered LOC

ASSESSMENT DETAILED EXAM Vital signs SAMPLE history Head-to-toe exam, including neurological and GCS Further bandaging and splinting Continuous observation

PUPILS

POSTURING

MANAGEMENT OF THE HEAD TRAUMA PATIENT Stabilize the c-spine Secure and maintain the airway Ventilate at about 15 breaths/min. Prevent hypoxia Hyperventilate only patients with the herniation syndrome Coma, BP, Respiration, bradycardia

AIRWAY CONTROL CANNOT BE OVEREMPHASIZED HEAD TRAUMA AIRWAY CONTROL CANNOT BE OVEREMPHASIZED 19

MANAGEMENT Record baseline exam Maintain good circulation Neuro, GCS & pupils Vital signs Maintain good circulation BP 110-120 systolic Continually monitor and record observations Prompt transport

PITFALLS & PROBLEMS Anticipate c-spine injuries Protect the airway - prevent aspiration Prevent hypoxia Prevent shock IV fluids and PASG are OK

PITFALLS & PROBLEMS Be prepared for seizures Rapidly deteriorating condition requires rapid hospital treatment Assess for other causes of altered LOC Hypoglycemia Alcohol Drugs

SUMMARY Follow patient assessment Protect c-spine, airway, and circulation Record frequent vital signs, neuro, pupils, and GCS Prompt transport

QUESTIONS?