Head Injuries

Overview of Head Injuries

• Head injury refers to damage to the head from trauma.
• Not all head injuries indicate brain injury (Traumatic Brain Injury - TBI).
• TBI is caused by an external force and can disrupt daily life.
• Common causes:
  • Falls (48%)
  • Motor vehicle accidents (14%)
  • Being struck by objects (15%)
  • Assaults (10%)
• Around 5.3 million people live with TBI-related disabilities.
• Prevention strategies are key to reducing TBIs.

Types of Brain Injury

• Primary Injury: Immediate damage from the trauma (e.g., contusions, skull fractures).
• Secondary Injury: Evolves over hours/days due to lack of oxygen/glucose to cells; crucial for early management of TBI.
• Conditions affecting secondary injury:
  • Intracranial hemorrhage
  • Cerebral edema
  • Intracranial hypertension
  • Seizures
  • Systemic effects (e.g., hypotension, infection, electrolyte imbalances).

Components of the Cranial Vault

• Contains:
  • Brain
  • Blood
  • Cerebrospinal Fluid (CSF)
• Monro–Kellie Hypothesis: A closed system; increase in one component (e.g., blood) requires a decrease in another (e.g., CSF) to maintain pressure.

Scalp and Skull Injuries

• Superficial injuries: abrasions, contusions, lacerations, hematomas.
• A skull fracture is a break caused by trauma; types include:
  • Linear: Simple break
  • Comminuted: Multiple fractures
  • Depressed: Skull pushed inward
  • Basal: At the base of the skull.

Symptoms of Skull Fractures

• Symptoms vary by severity/location; localized pain suggests fractures.
• Basal Skull Fractures: May lead to CSF leaks, hearing loss, bruising (Battle sign).
• CT scans diagnose fractures, MRI for detailed brain injury.
• Treatment: Monitoring & possibly surgery for depressed fractures.

Traumatic Brain Injuries (TBI)

• Closed TBI: Blunt trauma without skull penetration.
• Open TBI: Penetrating injury (e.g., gunshot), exposes brain.
• Focal Injuries: Localized damage (e.g., contusions, hematomas).
• Diffuse Injuries: Widespread damage (e.g., concussions, diffuse axonal injury).
• Concussion: Loss of neurologic function without structural damage; common in sports.
• Diffuse Axonal Injury (DAI): Severe injury with widespread axonal damage.

Hematomas

• Blood collections within the brain:
  • Epidural: Between skull and dura; rapid pressure buildup, emergency.
  • Subdural: Between dura and brain; can be acute or chronic.
  • Intracerebral: Within brain tissue; management focuses on controlling ICP and supportive care.

Managing Increased Intracranial Pressure (ICP)

• ICP increases from edema or hematoma; requires aggressive monitoring & treatment.
• Initial management:
  • Preserve brain homeostasis
  • Prevent secondary injury
• Symptoms of increased ICP include:
  • Changes in LOC (Cushing’s reflex: change in heart rate, BP).
• Interventions to manage ICP:
  • Elevate head
  • Maintain oxygenation
  • Prevent temperature spikes
  • Administer sedation as needed.

Nursing Assessments

• Regular assessments include:
  • Glasgow Coma Scale (GCS) for LOC
  • Vital signs monitoring
  • Neurological checks (pupil response, motor function).
• GCS ranges:
  • 3-8: severe injury
  • 9-12: moderate injury
  • 13-15: mild injury.

Long-Term Recovery and Rehabilitation

• Recovery may continue for years; focused rehabilitation helps patients regain function.
• Complications include infections and psychological impacts.
• Education for family on monitoring complications and support systems is crucial.

Conclusion

• TBI management is multidisciplinary, involving ongoing assessments, monitoring, and family support systems.
• Successful recovery includes addressing both physical and psychological changes post-injury.