Head injury: Causes, Types, Treatmennt

Head injury:

Head injury can include fracture to the skull or face. Direct injuries to brain (as from a bullet) and indirect injuries to the brain (Such as concussion, confusion, contusion or Intra cranial hemorrhage).

1.     Concussion: A temporary loss of consciousness that results from a depression of the skull bone.

2.     Confusion : A temporary loss of consciousness that results from a transcient interruption of the brain' s normal function.

3.     Contusion: A bruising of the brain tissue. Actual small amount of bleeding into the brain tissue.

4.    Intra cranal hemorrage : Significant bleeding into a space or a potential space between the skull and the brain this is serious complication of a head injury with a high mortality rate due to raising [TCP] Intra Cranial Pressure and potentially for brain herniation .

Intra cranial hemorage [ICH] can be classified as

a.     Epidural Haematomas

b.     Subdural Hematoms

c.      Subarachnoid Hematoms depending upon the site of bleeding

Causes :

Head injury commonly occurs from

1.     motor vehicle accident

2.     assaults

3.     falls.

Types :

1.     Open head injury :Any time the skull is fractured the patient is said to be have on open head injury.

2.     Closed head injury :Any time an internal injury occurs inspite of the skull being intact the term is closed head injury.

Primary assessment:

1.     Airway: Asses for vomitus bleeding or foreign objects obstructing the mouth or airway.

2.     Breathing: Asses for slow or shallow respiration

3.     Circulation: Asses vital signs and watch for bleeding.

Primary intervention:

1.     Open the airway using the jaw thrust technique without heat tilt.

2.     Administer high flow O₂ (Oxygen)

3.     Assist inadequate respiration with a bag valve mask.

4.     Control bleeding, Do not apply a bulky lose dressing Do not attempt to stop the flow of blood or CSF (cerebra spinal fluid

5.     Initiate an Intravenous line.

Subsequent assessment :

1.     History: Mechanism of injury, Duration of loss of consciousness position found.

2.     Level of consciousness: By Glasgow coma scale, score.

3.     Vital signs: Hypertension, Changes in respiration or apnea may indicate head injury.

4.     Seizure activity: Do not attempt to restrain during the seizure activity, Put airway to prevent tongue bite.

5.     Battle' s sign: A bluish discolouration behind the ears (indicates the possible basal skull fracture)

6.     Rhinnorhea : Indicates the leakage of CSF through the ears)

Treatment intervention :

1.     Keep the neck in a neutral position with the cervical spine immobiliyed

2.     Hyperventilation to reduce ICP

3.     Establish an intravenous line

4.     Be prepared to manage seizure

5.     Maintain normal temperature

6.     Pharmacological intervention

Prepare for immediate surgical intervention before patient shows an evidence of neurological deterioration.