Head injury
This presentation is the property of its rightful owner.
Sponsored Links
1 / 56

Head Injury PowerPoint PPT Presentation


  • 185 Views
  • Uploaded on
  • Presentation posted in: General

Head Injury. Saurabh Sinha Department of Clinical Neurosciences Western General Hospital. Age Groups. Mechanisms of Injury. What now?. Resuscitation. Aairway with cervical spine control Bbreathing Ccirculation. Traumatic Brain Injury. Immediate impact injury

Download Presentation

Head Injury

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Head injury

Head Injury

Saurabh Sinha

Department of Clinical Neurosciences

Western General Hospital


Age groups

Age Groups


Mechanisms of injury

Mechanisms of Injury


What now

What now?


Resuscitation

Resuscitation

  • Aairway with cervical spine control

  • Bbreathing

  • Ccirculation


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


Head injury

Aims

  • Prevent secondary brain injury

  • Rapid transfer to hospital


Brain herniation

Brain Herniation


Uncal herniation

Uncal Herniation


Midbrain infraction

Midbrain Infraction


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


Dilated pupil

Dilated Pupil


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)


Subconjunctival haemorrhage

Subconjunctival Haemorrhage


Panda eyes

Panda Eyes


Battle s sign

Battle’s Sign


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


Skull fracture

Skull Fracture


Depressed skull fracture

Depressed Skull Fracture


Aerocoele

Aerocoele


Penetrating injury

Penetrating Injury


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 PTA1 in 6700

    • Skull fracture1 in 81

    • Skull fracture & PTA1 in 29

  • GCS 9-14 (1:51)1 in 180

    • Skull fracture1 in 5

  • GCS 3-8 (1:7)1 in 27

    • Skull fracture1 in 4


Indication for urgent ct ns referral

Indication for urgent CT/NS referral

  • 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


Contusion

Contusion


Multiple contusions

Multiple Contusions


Extradural haematoma

Extradural Haematoma


Subdural haematoma

Subdural Haematoma


Chronic subdural haematoma

Chronic Subdural Haematoma


Diffuse axonal injury

Diffuse Axonal Injury


Extradural haematoma1

Extradural Haematoma


Skin preparation

Skin Preparation


Craniotomy mark

Craniotomy Mark


Opening

Opening


Head injury

Dura


Subdural haematoma1

Subdural Haematoma


Subdural collection

Subdural Collection


Haemostasis

Haemostasis


Monitoring

Monitoring


Icp monitoring

ICP Monitoring


Gcs chart

GCS Chart


Outcome at 1 year

Outcome at 1 year


Outcome wrt haematoma

Outcome wrt Haematoma


Recovery

Recovery


Use of helmets

Use of Helmets


Head injury management

Head Injury Management


  • Login