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Head Injury. Saurabh Sinha Department of Clinical Neurosciences Western General Hospital. Age Groups. Mechanisms of Injury. What now?. Resuscitation. A airway with cervical spine control B breathing C circulation. Traumatic Brain Injury. Immediate impact injury

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Presentation Transcript
Head injury

Head Injury

Saurabh Sinha

Department of Clinical Neurosciences

Western General Hospital





Resuscitation
Resuscitation

  • A airway with cervical spine control

  • B breathing

  • C circulation


Traumatic brain injury
Traumatic Brain Injury

Immediate impact injury

  • Contusions and lacerations

  • Diffuse damage to white matter

  • Other types of diffuse brain injury

    Primary complications

  • Intracranial haemorrhage

  • Brain swelling

    Secondary complications

  • Brain damage secondary to raised ICP

  • Hypoxic brain damage

  • Infection


Aims

  • Prevent secondary brain injury

  • Rapid transfer to hospital





Cerebral physiology
Cerebral Physiology

  • Intracranial pressure (ICP) 0-10 mmHg

  • Cerebral perfusion pressure (CPP) >60 mmHg

  • Obligative aerobic glycolysis

  • Cerebral blood flow (CBF) maitained by autoregulation


Severe head injury
Severe Head Injury

  • Raised ICP

  • Reduced CPP

  • Loss of autoregulation

  • Neuroexcitotoxicity


Raised icp
Raised ICP

  • Seizures

  • Brain swelling

  • Vasogenic oedema

  • Intracranial haematoma

  • Hypercarbia

  • Hypoxia


Neurological assessment
Neurological Assessment

  • Level of consciousness (GCS)

  • Pupillary reaction to light

  • Limb movements

  • History


Complicating factors
Complicating Factors

  • Alcohol

  • Drugs

  • Epilepsy

  • Stroke

  • Cervical spine injury


The glasgow coma scale and score

Eye (1-4)

open spontaneously

open to speech

open to pain

no opening

Motor (1-6)

obeys commands

localises to pain

normal flexion

abnormal flexion

extension

no movement

Verbal (1-5)

orientated

confused

inappropriate words

incomprehensible sounds

none

GCS 3-15

Best score using upper limbs

Special cases

dysphasia

periorbital oedema

endotracheal tube/tracheostomy

The Glasgow Coma Scale and Score


Definition of coma
Definition of Coma

  • GCS 8 or less

  • No eye opening

  • Does not speak

  • Does not obey commands



Signs
Signs

  • Penetrating Injury

  • Scalp laceration or haematoma

  • Periorbital haematoma

  • Blood or CSF from nose

  • Blood or CSF from ear

  • Battle’s sign

  • Cranial Nerve (eye movements, facial weakness)





Indications for skull x ray
Indications for skull X-ray

  • Orientated Patients

    • History of LOC/amnesia

    • Suspected penetrating injury (?CT)

    • CSF/Blood from ear/nose

    • Scalp laceration (to bone or >5cm), bruise or swelling

    • Persistent headache or vomiting

    • Children

      • Fall from significant height

      • Onto hard surface

      • Tense fontanelle

      • Suspected NAI

  • Patients with impaired consciousness or neurological signs

    • All patients unless CT or neurosurgical transfer arranged






Risk of operable intracranial haematoma in head injured patients
Risk of operable intracranial haematoma in head injured patients

  • GCS 15 (1:3615) 1 in 31300

    • With PTA 1 in 6700

    • Skull fracture 1 in 81

    • Skull fracture & PTA 1 in 29

  • GCS 9-14 (1:51) 1 in 180

    • Skull fracture 1 in 5

  • GCS 3-8 (1:7) 1 in 27

    • Skull fracture 1 in 4


Indication for urgent ct ns referral
Indication for urgent CT/NS referral patients

  • Coma persisting after resuscitation

  • Deteriorating conscious level or progressive neurological signs

  • Skull fracture & confusion/seizure/neuro symptoms or signs

  • Open injury: compound depressed #, gunshot or penetrating injury


Haematoma
Haematoma patients


Contusion
Contusion patients










Opening
Opening patients


Dura patients




Haemostasis
Haemostasis patients


Monitoring
Monitoring patients


Icp monitoring
ICP Monitoring patients


Gcs chart
GCS Chart patients




Recovery
Recovery patients


Use of helmets
Use of Helmets patients



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