HEAD INJURY
It is defined as injury involving the scalp,the skull or the brain tissue with or without loss of consciousness
Causes
*commonest cause:Road traffic accident
*Others:fall from heights,voilence
MECHANISM
*Acceleration-decelaration injury
*Rotational force
*Crush injury
*Penetrating injury
SITES
*Scalp:laceration,avulsion
*Skull:fracture
*Brain tissue
a)Primary Injury
i)Concussion
ii)Contusion
b)Secondary brain injury
Management
1)primary survery and resuscitation
2)secondary survey
3)Definitive management
PRIMARY SURVEY AND RESUSCITATION
Take brief history and physical examination to ascertain the cause,mechanism,severity of injury,loss of consciousness
RESUSCITATION:
A-Airway and cervical control
B-Breathing and ventilatory support
C-Circulation and haemorrhage control
D-Disability and dysfunction of CNS
E-Environment and temperature control
SECONDARY SURVEY
i)Detailed history
ii)Detailed physical examination
a)General physical examination from head to toe as patient may have other injuries
b)Glasgow coma scale score-helps to classify head injury
13-15:mild head injury
9-12:moderate head injury
3-8: severe head injury
c)Pupils-pupillary light reflex
d)Ears and nose : bleeding,loss of cerebrospinal fliud from nostril(Rhinorrhoea) or from the ears (otorrhoea)
e)Lateralizing signs:focal signs such as cranial nerve palsies,hemiparesis,sensory changes,abnormal reflexes and posture
f)vitals signs: Bp,pulse rate,respiration,temperature should be monitored every 30mins
Note:other sign of head injury
*cushing's relfex
*Hyperreflexia in tendons
INVESTIGATIONS
-Skull and cervical xray
-CT scan
-FBC and differentials
-Serum urea,electrolytes & creatinine
-Random blood glucose
DEFINITIVE SURGICAL TREATMENT
1)Definitive burr hole surgery
2)craniotomy:the whole cranium is removed and replaced after hematoma is evacuated
3)Craniectomy: the bone removed over the affected area and replaced after the hematoma has been evacuated
COMPLICATIONS OF HEAD INJURY
EARLY
cerebral odema
Fat embolism
Headache
Cranial nerve injuries
LATE
Meningitis
Cerebral abscess
Post concussional syndrome
Post traumatic epilepsy
INDICATIONS FOR CT-SCAN IN HEAD INJURY
Severe head injury
Convulsion after trauma
Presence of lateralizng signs
Deteriorating level of consciousness
