1. HEAD INJURIES

2. 2 Anatomy  Cerebrum  Cerebellum  Brain Stem  Cranium

3. Traumatic Brain Injury  Leading cause of disability and death in adults under the age of 45 is brain injury – not cancer, heart disease, diabetes or other causes.  Even a mild brain injury can lead to a life-long disability.  Additionally, the threshold for re-injury is lowered making further damage more likely.  Getting early medical treatment and having a gradual and medically supervised return to activity are important steps in reducing the potential for a concussion to become a cause of death or disability. 3

4. Traumatic Brain Injury  Traumatic brain injury occurs at an annual rate of 500/100,000 individuals (approximately 166,455 in Canada).  That is 456 people every day or one person injured every three minutes in Canada.  It occurs at a rate 100 times that of spinal cord injury.  It is estimated that the direct and indirect costs associated with Traumatic Brain Injury are $3 billion annually in Canada. 4

5. 5 Facial and Scalp Injuries  Any trauma to the head is maybe accompanied by external wounds. The main problems to watch for are: Airway problems due to bleeding in the mouth Potential C-spine problems Potential internal head injury

6. 6 Treatment  Treatment of the contusions or lacerations is routine  Special considerations: The scalp is susceptible to heavy bleeding. Direct pressure may be difficult to apply via a bandage. Use your hand or the weight of the head until clotting takes place. Swelling associated with closed wounds usually responds to ice packs. Never bandage the jaw so that the patient’s mouth will not open.

7. 7 Jaw Fractures  Most often occur near the hinge  One-sided or bilateral  Can be very painful and make it difficult for the patient to talk

8. 8 Signs and Symptoms  Facial deformity, asymmetry, swelling  Difficulty in talking and swallowing  Bleeding  Inability to open mouth or clench the teeth  Bite irregularity  Pain

9. 9 Treatment  Maintain an open airway  Apply oxygen  Stabilize the cervical spine  Apply cervical collar, if this does not interfere with breathing or cause more pain  If unable to apply collar, stabilize the jaw and immobilize head with padding or blankets  Stop external bleeding - direct pressure  Recommend the patient seek further medical aid

10. 10 Skull Fractures  Simple skull fracture is not easily detectable  By itself, it is not a serious injury  Many severe head injuries are associated with spinal damage  There are a number of associated injuries that are life threatening, including: Linear fractures that may occur at or beyond the point of impact Depressed skull fractures Potential C-spine problems Potential internal head injury

11. 11 Signs and Symptoms  May appear as open or closed fracture, with or without detectable deformity  Skull may be depressed into the brain  Bleeding from the ears, nose or mouth  Clear, straw-coloured fluid (cerebrospinal fluid) may leak from ears or nose  This type of injury should be suspected if a patient has sustained a severe impact to the jaw

12. 12 Treatment  Airway  Activate EMS  Administer Oxygen  Be on alert for presence or development of internal head injuries = Load and Go  Treat as C-spine injury and backboard  Bandage a dressing with enough pressure to control bleeding  Allow any fluids to drain; apply loose dressing  Record information

13. 13 Recording Information  Time and details of the incident  Presence or absence of signs and symptoms of spinal disabilities or internal head injury  Duration of unresponsiveness, if any  Note changes in vital signs or pupils  Blood or fluid appearing from ears, nose or mouth

14. 14 Concussion  Latin “to shake violently”  Causes cerebral tissue to impact with the inside of the skull resulting in temporary disruption of brain function  Effect is usually proportional to magnitude of the blow  Often associated with impacts with hard objects, they can also occur when patients have worn helmets

15. 15 Signs and Symptoms  Loss of consciousness, however brief, is an unequivocal sign of concussion, but not its severity  Lowered level of consciousness slightly dazed to being completely unresponsive  Degree of damage is never obvious and can lead to intracranial pressure, so monitor closely

16. Signs & Symptoms  Memory or Orientation Problems: General confusion Memory loss Unaware of time, date, place Repeatedly asks the same questions 16

17. Signs & Symptoms Typical Symptoms headache feeling dazed or slow dizziness seeing stars ringing in ears sleepiness loss of vision, double or blurred vision nausea Physical Signs  poor coordination  vacant stare  vomiting  slurred speech  slow to answer questions  poor concentration  unusual/inappropriate emotions  personality changes 17

18. 18 Treatment  Airway – be prepared for AR  Activate EMS  Oxygen  Check constantly for changes  C-Spine protocol with spinal precautions  Maintain normal body temperature  Give nothing by mouth  Give Concussion Information and Management card to patient or patient’s family

19. The CSPS, in conjunction with BrainTrust Canada has produced cards in both official languages, for distribution by patrollers year round. 19

20. Use of the card  Having written medical information about the seriousness of brain injury and what to watch for, will assist those who have been injured or are assisting someone who has been injured to make appropriate decisions about seeking additional medical treatment.  Any incident that has produced symptoms of a concussion or other brain injury, should have a patroller involved providing supportive care and an information card about the seriousness of brain injury. 20

21. 21 Record Information  Time and details of incident  Presence or absence of signs and symptoms of spinal disabilities or external head injury  Duration of unresponsiveness, if any  Pay particular attention to any change in vital signs and the pupils Any patient who has lost consciousness should be kept under medical supervision for 24 hours after the injury

22. 22 Cerebral Contusion  Bruising of the brain tissue  Like concussion, only worse  Brain directly below or on the opposite side of blow may be injured  Possibility of intracranial pressure developing

23. 23 Signs and Symptoms  Signs and symptoms are same as a concussion, but may be more pronounced or last longer  May also have symptoms of intracranial pressure or bleeding  Obvious external head injury is not a necessary condition; neither is loss of consciousness  Return to consciousness is usually followed by a period of confusion and amnesia

24. 24 Treatment  Airway – be prepared for AR  Activate EMS  Oxygen  Check constantly for changes  C-Spine protocol with spinal precautions  Maintain normal body temperature  Give nothing by mouth  Give Concussion Information and Management card to patient or patient’s family

25. 25 Intracranial Pressure (ICP)  Skull can be thought of as a rigid box that contains a fixed volume  Increased volume of fluid leads to less space for the brain  Two major consequences: Interferes with oxygenation of the brain cells, leading to hypoxia Pressure on the brain stem into the hole in the base of the skull

26. 26 Intracranial Bleeding  Following head injury there is no way of knowing whether intracranial bleeding will occur  Occurs outside or inside the dura (the lining of the brain) bleeding outside the dura is epidural bleeding below the dura is subdural  Signs and symptoms may vary

27. 27 Signs and Symptoms  Altered LOC  Bleeding or fluid from the nose, mouth or ears  Convulsions  Nausea  Vomiting, especially by children  Unusual pupil reactions  Bounding +/or very slow pulse  Cessation of breathing or patterned breathing  Partial or complete paralysis  Battle’s signs  Discolouration below the eyes “Racoon Eyes”  Abnormal or violent behaviour  Confused, disturbed speech  Headaches  Restlessness  Fatigue

28. 28 Unusual Pupil Reactions Condition of Pupils Suspect Fixed and dilatedSevere damage to the central functions of the brain One pupil dilated and one pupil normal Damage is limited to one side of the brain Fixed, constricted pupils Drug abuse or severe irreparable brain damage Constricted pupils that later become fixed and dilated Worsening condition

29. Treatment (after determining LOC) Full control of faculties  Continuous monitoring  Close observation for: slurred speech disorientation uncoordinated movements weakness  Look for signs of alcohol or drug use  Smell breath but never assume “drunkeness” Unresponsive  If patient becomes unresponsive, it is a serious complication  Check respiration, pulse, pupil response, response to pain stimuli  Monitor continuously  Monitor pupil reaction  Monitor and maintain airway 29

30. 30 Record Information  Time of incident  Details of the incident  Presence or absence of signs and symptoms such as: confusion, movement or feeling in the limbs, vomiting, pupil response, etc.  How long the patient was unresponsive, and the patient’s changes in response  Blood or fluid appearing from ears, nose or mouth.

31. 31 Severity  The severity of potential brain injuries can be evaluated by monitoring: Changes in the level of consciousness (assess every five minutes) Pupil size and response Extremity weakness