Head Injury

1. Head Injury

2. Head Injury • Any trauma to thescalp,skull,orbrain • Head traumaincludes an alteration inconsciousness 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 InjuryTypes of Head Injuries • Scalp lacerations • The most minor type of head trauma • Scalp is highly vascular  profuse bleeding • Major complication is infection

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

7. Head InjuryTypes 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 InjuryTypes 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. 55-13

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 InjuryTypes 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 InjuryTypes of Head Injuries • Minor head trauma • Postconcussion syndrome • 2 weeks to 2 months • Persistent headache • Lethargy • Personality and behavior changes

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

14. Head InjuryTypes 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 InjuryPathophysiology • Diffuse axonal injury (DAI) • Widespread axonal damage occurring after a mild, moderate, or severe TBI • Process takes approximately 12-24 hours

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

17. Head InjuryComplications • Epidural hematoma • Results from bleeding between the dura and the inner surface of the skull • A neurologic emergency • Venous or arterial origin

18. Head InjuryComplications • 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. 55-15

20. Head InjuryComplications • 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 InjuryComplications • 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 InjuryComplications • Subdural hematoma • Subacute subdural hematoma • Occurs within 2-14 days of the injury • Failure to regain consciousness may be an indicator

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

24. Head InjuryDiagnostic 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 InjuryNursing ManagementNursing Assessment • GCS score • Neurologic status • Presence of CSF leak

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

27. Head InjuryNursing ManagementPlanning • Overall goals: • Maintain adequate cerebral perfusion • Remain normothermic • Be free from pain, discomfort, and infection • Attain maximal cognitive, motor, and sensory function

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

29. Head InjuryNursing ManagementNursing implementation Acute Intervention • Maintain cerebral perfusion and prevent secondary cerebral ischemia • Monitor for changes in neurologic status

30. Head InjuryNursing ManagementNursing implementation Ambulatory and Home Care • Nutrition • Bowel and bladder management • Spasticity • Dysphagia • Seizure disorders • Family participation and education

31. Head InjuryNursing ManagementEvaluation Expected Outcomes • Maintain normal cerebral perfusion pressure • Achieve maximal cognitive, motor, and sensory function • Experience no infection, hyperthermia, or pain