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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
slide8
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
  • 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
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