Head Injury

Head Injury

Head Injury • Any trauma to the scalp, skull, or brain

• Head trauma includes an alteration in consciousness no matter how brief

Head Injury • Causes – Motor vehicle accidents – Firearm-related injuries – Falls – Assaults – Sports-related injuries – Recreational accidents

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

Head Injury Types of Head Injuries • Scalp lacerations – The most minor type of head trauma – Scalp is highly vascular  profuse bleeding – Major complication is infection

Head Injury Types of Head Injuries • Skull fractures – Linear or depressed – Simple, comminuted, or compound – Closed or open – Direct & Indirect – Coup & Contrecoup

Head Injury Types of Head Injuries • Skull fractures – Location of fracture alters the presentation of the manifestations – Facial paralysis – Conjugate deviation of gaze – Battle’s sign

Head Injury Types 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

Battle’s Sign

Fig. 55-13

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+++

Head Injury Types 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

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

Head Injury Types of Head Injuries • Major head trauma – Includes cerebral contusions and lacerations – Both injuries represent severe trauma to the brain

Head Injury Types 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

Head Injury Pathophysiology • Diffuse axonal injury (DAI) – Widespread axonal damage occurring after a mild, moderate, or severe TBI – Process takes approximately 12-24 hours

Head Injury Pathophysiology • Diffuse axonal injury (DAI) – Clinical signs: •  LOC •  ICP • Decerebration or decortication • Global cerebral edema

Head Injury Complications • Epidural hematoma – Results from bleeding between the dura and the inner surface of the skull – A neurologic emergency – Venous or arterial origin

Head Injury Complications • Subdural hematoma – Occurs from bleeding between the dura mater and arachnoid layer of the meningeal covering of the brain

Epidural and Subdural Hematomas

Epidural Hematoma

Subdural Hematoma

Fig. 55-15

Head Injury Complications • 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

Head Injury Complications • 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

Head Injury Complications • Subdural hematoma – Subacute subdural hematoma • Occurs within 2-14 days of the injury • Failure to regain consciousness may be an indicator

Head Injury Complications • Subdural hematoma – Chronic subdural hematoma • Develops over weeks or months after a seemingly minor head injury

Head Injury Diagnostic 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

Head Injury Nursing Management Nursing Assessment – GCS score – Neurologic status – Presence of CSF leak

Head Injury Nursing Management Nursing Diagnoses – Ineffective tissue perfusion – Hyperthermia – Acute pain – Anxiety – Impaired physical mobility

Head Injury Nursing Management Planning – Overall goals: • Maintain adequate cerebral perfusion • Remain normothermic • Be free from pain, discomfort, and infection • Attain maximal cognitive, motor, and sensory function

Head Injury Nursing Management Nursing implementation

Health Promotion • Prevent car and motorcycle accidents • Wear safety helmets

Head Injury Nursing Management Nursing implementation Acute Intervention • Maintain cerebral perfusion and prevent secondary cerebral ischemia • Monitor for changes in neurologic status

Head Injury Nursing Management Nursing implementation Ambulatory and Home Care • Nutrition • Bowel and bladder management • Spasticity • Dysphagia • Seizure disorders • Family participation and education

Head Injury Nursing Management Evaluation Expected Outcomes • Maintain normal cerebral perfusion pressure • Achieve maximal cognitive, motor, and sensory function • Experience no infection, hyperthermia, or pain