-
what are 3 injuries to the scalp or skull?
- scalp lacerations
- skull #
- damage to underlying structures
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what do serious head injuries usually have as well?
C spine damage
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there is a significant association between reduced LOC and ...........
C spine injuries
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what do you do if there is a significant head injury?
full immobilisation
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why do scalp lacerations sometimes appear worse than they are? and what does this course?
- scalp is very vascular
- distracts you from other injuries
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when might a scalp laceration cause hypovolaemic shock?
- artery has been damaged
- children
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what is a laceration?
deep cut or tear to the skin
-
what is a skull #?
- injury to rigid box around the brain
- indicate significant force
-
what are common complications of a skull #?
damage to brain structures underneath
-
what are the 4 types of skull #?
- linear
- depressed
- base of skull
- open
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what is a linear skull # like?
a crack in an egg
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where does a linear skull # commonly occur?
temporal- parietal region
-
why is it difficult to diagnose without scans?
may present without usual signs of deformity
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what happens if a scalp laceration occurs above a linear #?
risk of infection
-
what is a depressed #?
- results from high energy direct blunt trauma to a small surface
- e.g. hammer/baseball bat
-
what do the bone fragments do in a depressed#?
penetrate the brain tissue causing damage
-
what is a base of skull # associated with?
- high energy trauma
- normally diffuse (non direct)
- e.g. fall from height
-
what are specific basal skull #?
- blood/ CSF flowing from nose/ ears
- infection risk as direct path to CNS
-
what is an open skull # associated with?
trauma to multiple body system
-
what may be exposed to the environment in a open skull #?
- brain tissue
- massive infection risk
-
what is a TBI?
- traumatic brain injury
- caused by trauma to the head
-
what are other complications of TBI?
- hypoxaemia
- hypotension
- intracerebral haematoma
-
what is a primary brain injury?
- injury resulting from impact itself
- cannot be treated by us- damage already done
-
what is secondary brain injury?
- occurs following primary event
- result of hypoxia, hypoperfusion or hypercarbia
-
what is concussion?
- temporary disturbance in brain function
- shaking or rattling of the brain
-
what are some symptoms of concussion?
- confusion
- disorientation
- possible LOC
-
what is retrograde amnesia?
inability to recall past memories
-
what is anterograde amnesia?
inability to create new memories
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what is a coup injury?
primary impact
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what is a contrecoup?
- injury on the opposite side (secondary impact) as well as injury to the primary impact site
- injury to 2 regions
-
what is a intracranial bleed a complication of?
TBI
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where can intracranial haemorrhage occur?
- extradural/ epidural
- sub dural - acute or chronic
- sub arachnoid
-
what is an epidural haematoma a result of?
- direct blow
- usually result of an arterial bleed
-
where does the bleeding occur in a epidural haematoma?
- bleeding outside dura mater
- forms haematoma and compresses brain
-
what is a lucid interval?
- period of apparent recovery post injury
- then deteriorate further
-
what is the lucid interval due to?
haematoma growing
-
why does the intracranial pressure rise?
skull is a closed box
-
what is a sub dural haematoma?
- haematoma between the dura and arachnoid layer
- often slower venous bleed
- develops gradually
-
what is an acute sub dural haematoma?
- injuries resulting in deceleration and falls
- blood may spread in sub dural space over 1 or both hemispheres
-
what is a chronic sub dural haematoma?
- occurs weeks- months
- sometimes no history of injury
- more common in pt with cerebral atrophy (elderly/alcoholics)
-
when does a sub arachnoid haemorrhage occur?
- almost always medical
- type of stoke- ruptured berry aneurysm
-
where does the blood spread in a sub arachnoid haemorrhage?
sub arachnoid space around brain and spinal cord causing increase in ICP
-
what is a cerebral contusion?
- bruising, swelling
- brain hitting skull's inside
- causing physical damage to brain tissue
- coup / contra- coup pattern
-
what happens in a cerebral contusion?
- brain closed box
- pressure increases as brain swells
- blood flow to brain decreases
-
why is early detection of increased ICP critical?
- if pressure inside skull goes above average BP, blood flow to brain stops
- increased ICP can force brain downwards into spinal canal, crushing it
-
what is cushing triad?
- altered breathing
- slow pulse
- increase bp
-
how does the body respond to ICP?
- increase BP
- increased BP moves blood into brain against rising ICP
- heart rate falls in response to rising BP
-
what are signs and symptoms of a head injury?
- lacerations
- boggy area when palpating
- visible deformities
- battles sign
- CSF
- cushing's triad
- non reactive or unequal pupils
- dizziness
- nausea and vomiting
- abnormal pupils
- visual disturbance (seeing double, blurred, stars)
- severe headaches
- abnormal behaviour- aggressive, personalities changes
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what are late signs specific to basal skull #?
- periorbital ecchymosis (panda eyes)
- battles sign- brusing behind the ears
-
what is the best indicator of patients condition?
-
what are the minimum observations for a head injury?
- RR and depth
- AVPU
- Spo2
- PR and character
- BP
- colour
- GCS
-
what are the 3 categories for GCS?
- Eye opening
- verbal response
- motor response
-
what are the scores for eye opening? GCS
- spontaneous- 4
- to voice- 3
- to pain- 2
- none- 1
-
what are the scores for verbal response? GCS
- oriented- 5
- confused- 4
- inappropriate words- 3
- incomprehensible sounds- 2
- none- 1
-
what are the scores for motor response?
- follows commands- 6
- localizes pain- 5
- withdraws- 4
- flexion- 3
- extension- 2
- none- 1
-
what is decorticate posturing?
- flexion of the elbows
- hands flexed on chest
-
what is decerebrate posturing?
- extension of the elbows
- hands flexed by side
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what is the modified paediatric verbal response GCS?
- 5- appropriate words, social smile, fixes eyes and follows
- 4- cries but consolable
- 3- persistently irritable
- 2- restless and agitated
- 1- none
-
what does a isolated head injury not cause?
-
what do signs of shock in head injured patients indicate?
other injuries are present
-
how should you manage a head injury?
- not- apply pressure to open or depressed skull fracture
- not- stop flow of blood or CSF from nose or ears
- not- removal of penetrating objects
- not- spend extended time on scene
- not- forget C spine
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