Closed Head Injuries

Course overview

Objectives Describe the anatomy and physiology of the brain and spine Identify signs and symptoms of closed head injuries Explain how to safely transport patients with closed head injuries Content Incidence 2 1 Morbidity 2 Mortality Anatomy and Physiology of the Brain and Spine 1 Spine 1 Spinous process 2 Cervical 3 Thoracic 4 Lumbar 5 Spinal Fluid 2 Spinal Cord 3 Brain 1 Skull 2 Meninges 1 Dura mater 2 Arachnoid mater 3 Pia mater 3 Gray matter composed of nerve cells 4 White matter covered nerve pathways that conduct messages of the brain 5 Brain stem center for involuntary functions temperature regulation respiratory and heart rate nerve function transmissions 6 Cerebrum main part of brain divided into two hemispheres with four lobes 7 Cerebellum center for equilibrium and coordination 8 Meninges coverings of the brain 9 Cerebral spinal fluid 4 Types of Skull Fractures 1 Basal 2 Compressed 3 Open 4 Linear 5 Types of Brain injuries 1 Concussion temporary disruption to brain without injury due to closed trauma 2 Contusion bruise of brain matter may be diffuse or localized to one area 3 Cerebral laceration 4 Space occupying lesions 1 Epidural bleed typically arterial with high emergent risk 2 Subdural typically venous may be acute or chronic 5 Penetrating wounds General Assessment Considerations for Brain Trauma Patients 1 Airway and Ventilation 1 Maintain airway 2 Assess for adequate ventilation 2 Mechanism of Injury 1 Consider the potential for blunt head trauma based on mechanism of injury 2 Assess the need to remove the helmet with proper spinal considerations if airway compromise or bleeding under the helmet is present 3 Spinal Immobilization 1 In patients with head injuries with altered mental status 2 Mechanism of injury that suggests the possibility of trauma to the spine 4 Respiratory Status brain injuries can cause irregular breathing patterns due to injuries affecting the brain stem 5 Complete a Neurological Exam 1 Appearance and behavior 1 Alert 2 Responds to verbal stimuli 3 Responds to painful stimuli 4 Unresponsive 2 Observe posture and motor behavior appropriate movement 3 Facial expression 4 Speech and language 5 Thoughts and perceptions 1 Logical 2 Ability to make decisions 6 Memory and attention 1 Assess orientation 1 person 2 place 3 time 4 purpose 2 Knowledge of recent events 7 Pupils 1 Equal 2 React to light 8 Vital signs 1 Blood pressure 1 systolic pressure increase 2 hypotension is associated with poorer outcomes in head injured patients 2 Pulse rate may be slower than normal if severe head injury 6 Management Considerations With Brain Trauma 1 Maintain airway throughout care 2 Administer oxygen by non rebreather mask maintain oxygen saturation 90 percent at all times Nasopharyngeal airways should not be used 5 Assist ventilation if indicated avoid hyperventilation except in specific circumstances 6 Transport Considerations 1 Head trauma patients with impaired airway or ventilation open wounds abnormal vital signs or who do not respond to painful stimuli may need rapid extrication 2 Head trauma patients must be transported to appropriate trauma centers 3 Head trauma patients may deteriorate rapidly and may need air medical transport 4 Adequate airway ventilation and oxygenation are critical to the outcome of head trauma patients 5 Head trauma patients frequently vomit keep suction available 6 Head trauma patient frequently have seizures 7 Refer to Brain Injury Foundation Guidelines Age Related Variations for Pediatric and Geriatric Assessment and Management of Brain Injury 1 Pediatric 2 Geriatric 9 Neurological examination considerations 1 Movement of extremities 1 absent or weak 2 note level of impairment 2 Respiratory ability 1 chest wall movement 2 abdominal Excursion 3 Sensation 1 present throughout body 2 absent note the specific level of 3 absent note the specific level of impairment altered sensation distal to injury jingling, numbness