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

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

3. 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

4. ANATOMY

5. 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

6. 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

7. 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

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

9. HEAD INJURIES SKULL INJURIES
Courtesy Roy Alson, MD

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

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

12. HEAD INJURIES EPIDURAL HEMATOMA

13. HEAD INJURIES SUBDURAL HEMATOMA

14. HEAD INJURIES INTRACRANIAL HEMORRHAGE

15. 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

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

17. PUPILS

18. POSTURING

19. 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

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

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

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

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

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

25. QUESTIONS?