Assessment and Resuscitation of Head Injury

Arputhamary

Assistant Nursing Superintendent, Kauvery Hospital Tennur, Trichy

Background

Definition

A head injury is any Trauma or damage to the scalp, skull & brain caused by an external force.

Etiology of Head Injury

  • Motor vehicle Accident
  • Falls
  • Assaults
  • Sports -Related Injury.

Anatomy of the head

Bone and Facial Bone

The skull is a bony structure that protects the brain and supports the face.

It’s composed of 22 bones, base.

The skull is composed of Cranial bones (8)

Frontal, parietal (2), temporal (2), occipital, sphenoid, and ethmoid.

Facial bones (14)

Mandible, maxilla (2), zygomatic (2), nasal (2), lacrimal (2), palatine (2), inferior nasal concha (2), and vomer.

Types of head injury

Concussion: A mild brain injury caused by a blow or jolt to the head, leading to temporary confusion, dizziness, or loss of consciousness

Contusion: A bruise on the brain tissue, often caused by direct impact to the head.
Skull Fracture: A break in one or more of the skull bones.

Hematoma: Collection of blood inside the skull, which can press on the brain.

Types include

  • Epidural hematoma: Between the skull and dura mater.
  • Subdural hematoma: Between the dura mater and brain
  • Intracerebral hematoma: Inside the brain tissue.
  • Penetrating Injury: When an object breaks through the skull and enters the brain (e.g., bullet or sharp object).
  • Diffuse Axonal Injury: Caused by shaking or strong rotation of the head, leading to widespread damage to brain cells.

Assessment

Head Injury Assessment

Image

Stabilization of the head Injury

  • Airway, Breathing, Circulation (ABCs): Ensure the patient is breathing and has stable vital signs.
  • Stabilize the neck and spine until spinal injuries are ruled out.
  • Oxygen is often administered, and intubation may be necessary.
  • IV fluids for blood pressure support.
  • Imaging: CT scan of the head is standard to detect bleeding, swelling, or skull fractures.

Signs and Symptoms

Pathophysiology

Explaining assessment to juniors

How Is a Head Injury Diagnosed?

Diagnosis test for Head Injury

  1. Clinical Feature
  2. Physical Examination
  3. Laboratory Study e.g. blood test
  4. Head X-ray
  5. CT Scan
  6. MRI

Management

Medical Management:

  • Anti-epileptic drugs
  • Pain Management
  • Antibiotics
  • Hemorrhagic control with Inj. Tranexemic acid

Surgical Management

Craniotomy

The surgical removal of part of the bone from the skull to expose the brain.

Cranioplasty: The surgical repair of a bone defect in the skull resulting from a previous operation or injury.

Nursing Management

  • Maintaining Optimal Blood Pressure: Controlling hypertension or hypotension to ensure adequate cerebral perfusion.
  • Oxygenation and Ventilation: Providing supplemental oxygen and ensuring adequate ventilation.
  • Temperature Management: Preventing hyperthermia or hypothermia.
  • Glucose Control: Maintaining normoglycemia.
  • Seizure Prophylaxis: Administering anticonvulsants to prevent seizures.
  • Intracranial Pressure (ICP) Management: Monitoring and managing ICP.

Our Goal

  • Prevent Secondary Brain Injury
  • Promote Optimal Recovery
  • Improve Patient Outcomes
  • Reduce Morbidity and Mortality
  • Multidisciplinary Approach

Why immediate treatment for Head Injury?

Immediate treatment for a head injury is crucial to prevent potentially life-threatening complications like brain damage and death.

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