1. Head Injury

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

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

4. 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

5. 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

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

7. 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

8. 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

9. Battle’s Sign
Fig

10. 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+++

11. 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

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

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

14. 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

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

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

17. 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

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

19. Epidural and Subdural Hematomas
Epidural Hematoma
Subdural Hematoma
Fig

20. 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

21. 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

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

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

24. 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

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

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

27. 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

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

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

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

31. 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