Head Injuries

*Head Injuries

*1,000,000 Pt’s /yr in A&E

*6000 severe – 40-50% die

*Biggest killer for 15-24’s

*Physiology

*Skin

*Skull

*Meninges

*Brain

*Brain sits in CSF fluid (acts as a shock absorber)

*Head Injury causes

*Falls (NB axial loading)

*Sports injuries

*Fights

*RTCs

*Get lots of info about M.O.I:

*When?

*How fast?

*How high?

*Where hit?

*How many impacts?

*What can go wrong?

*Skull fracture

*Contusion & laceration

*Concussion

*Extradural haemotoma

*Subdural haemotoma (slow killer – after 3 days – mortality ~50%)

*‘Compression’ (rise in ICP)

*Primary & secondary damage

*Concussion

*Shaking of the brain

*Temporary disturbance of function (‘stunned’)

*Usually no long term damage

*Symptoms?

*Concussion: Symptoms

*Headache (mild, generalised)

*Dizziness

*Nausea

*Confusion

*Loss of memory

*L.O.C

*Visual disturbances

*Concussion may be related to basilar skull fracture.

*Compression

*Increased ICP (bleeding or swelling)

*May occur straight after injury

*…OR days after!

*(so always ask about recent head injuries)

*Symptoms?

*Compression: Symptoms

*Deteriorating level of response (AVPU)

*Intense headache

*Nausea / vomiting

*Noisy breathing becoming shallow

*Slow, strong pulse

*One-sided weakness / paralysis

*Drowsiness

*Change in personality

*Severe amnesia

*Posturing

*Unequal pupils (NB late sign!)

*Seizures

*Lucid intervals

*Cushing’s Triad

*Increased BP

*Decreased Pulse rate

* Irregular breathing rate

*Skull Fracture

*Requires significant trauma

*Bruising usually develops a long time after the event

*Brain diagram

*Assessment: Primary Survey

*Danger (fights etc)

*Scene size-up (M.O.I)

*Response (AVPU)

*Airway (teeth, blood, L.O.C)

*C-Spine!!

*Vomiting

*Breathing (rate, regularity, depth)

*Circulation (pulse, bleeding, skin colour)

*Disability / dysfunction

*Event history – when depends on seriousness of Pt

999?

*Assessment (Dysfunction)

*Feel the scalp – deformity / swelling / bleeding?

*Check for CSF fluid (inside!)

*Check pupils (NB – alcohol/drugs)

*Level of response – A? V? P? U?

*Eyes

*Speech

*Motor response (squeeze fingers both sides)

*GCS score (IF you know it well!)

*Level of orientation (place, time, event, person)

*(But don’t take the piss)

*More Assessment!

*Lots of Obs!

*Pulse (rate / regularity / strength)

*Breathing (rate / regularity / depth)

*If available, ETA / HCP to get BP (or if serious)

*Outward signs (e.g. helmet damage)

*SAMPLE (inc. alcohol & drugs)

*Investigate symptoms & changes

*Pins and needles, numbness etc.

* If memory loss, what extent?

* If L.O.C, how long for? More than once?

*Changes in level of orientation (place, time, event, person)

*Investigate behaviour

NB – Complicated by alcohol

*Management

*C-spine? (Jaw thrust?)

*Position (sat up? Recov pos?)

*Oxygen

*HCP? Hospital? 999?

*Sort wounds (inspect fist!)

*CSF fluid?

*Reassure (if hyperventilating, control this)

*Paracetamol?

*Head injury advice (next slide)

*Advise not to drink / get high

*Advise not to ‘get back on the pitch’

*Advise they’re watched by a friend (why?)*And more OBS!

*Look out for…

* drowsiness

*Worsening headache

*Confusion & memory loss

*Behaviour changes

*One-sided weakness

*Dizziness

*Visual disturbances

*Bleeding / CSF

*Breathing problems

*Vomiting

*..Well.. bad stuff. Namely:

*NOTE – do they have CAPACITY?? Do they understand what’s going on? Can they remember & repeat the information?

*Sources

*http://www.nhs.uk/Conditions/Head-injury-minor/Pages/Treatment.aspx

*http://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/prehospitalcare/jrcalcstakeholderwebsite/guidelines/head_trauma_2006.pdf