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Flashcards in EAC Head injuries Deck (24):

aims of pre-hospital treatment in pt's suffering head injuries

The brain damage sustained at the time of injury cannot be treated.

YOUR JOB is to try and prevent it form getting worse.

This overrides treatment of relatively minor injuries.

Immediate removal to a hospital is vital.

ALWAYS CONSIDER C-SPINE. Is there clinical or mechanical indication?


Types of head injury

Scalp wound
Skull Fracture
Depressed Fracture of the Skull
Fractured Base of Skull


causation of:
Scalp Wound

Scalp wounds usually occur from direct violence e.g. assault, falls, RTC. The pt may be dazed or confused and could be suffering from concussion.

This type of wound usually bleeds quite considerably and in all directions, matting hair and running down the face. It can often be difficult to pinpoint the source and extent of the wound.


causation of:
Skull Fracture

Because fractures of the skull often involve brain damage, they are potentially serious incidents. Not only may the underlying brain be contused, but the risk of an intra-cranial blood clot is more then 60x greater when there is a skull fracture present. The skull may fracture in different places.


causation of:
Depressed Fracture of the Skull

This usually follows a direct blow and may be a closed or open injury. There may be a dent in the skull where the injury occurs. Careful handling is required to avoid any direct pressure to the site of the injury as underlying structures could be damaged.


causation of:
Fractured Base of Skull

A fractured base may be caused by indirect force. For example a blow or fall on the lower jaw, a fall onto the feet or lower part of the spine where the force is transmitted to the skull base.

A fractured base of skull may cause leak of cerebrospinal fluid CSF from the ear or nose. Signs might include a watery bloody discharge from the ear or nose or a bloodshot eye.


types of skull fracture:

Linear: where the break in the bone looks like a straight line

Depressed: where part of the skull is crushed inwards

Base of Skull: a fracture to the base of the skull

Open/compound: where the skin has broken and the surrounding tissue may be damaged

closed/simple: where the skin hasn't broken and the surrounding tissue isn't damaged


types of brain injury

Cerebral Contusion: bruising of the brain

Laceration: brain and tissue pulped or torn

Vascular damage: extradural haemorrhage or subdural bleeding


Cerebral Contusion

Bruising, swelling
Results form brain hitting skulls inside causing physical damage to brain tissue
Coup/Contra-coup pattern
Since brain is in closed box, pressure increases as brain swells, blood flow to brain decreases.


signs and symptoms of:
Cerebral Contusion

Personality changes
Potentially prolonged confusion and loss of consciousness
Paralysis (one side or total)
Unequal pupils


Epidural Haematoma

Usually associated with skull fracture in temporal area

Fracture damages artery on skull's inside

Blood collects in epidural space between skull and dura mater

Since skull is closed box, intracranial pressure rises


signs and symptoms of:
Epidural Haematoma

Loos of Consciousness followed by return of consciousness (lucid interval)


Deterioration of consciousness

Dilated pupil on side of injury

Weakness, paralysis on side of body opposite injury



Subdural Haematoma

Usually results from tearing of large veins between dura mater and arachnoid mater

Blood accumulates more slowly than in epidural haematoma

Signs and symptoms may not develop for days to weeks


signs and symptoms of:
Subdural Haematoma

Deterioration of consciousness

Dilated Pupil on side of injury

Weakness, paralysis on side of body opposite injury


N.B. because of slow or delayed onset, may be mistaken for CVA


Cerebral Laceration

Tearing of brain tissue

Can result from penetrating or blunt injury

Can cause:
-Massive destruction of brain tissue
-bleeding into cranial cavity with increased intracranial pressure


any patient who has been concussed...

is at risk of compression


head injury complications

early detection of increased intracranial pressure is critical

If pressure inside skull exceeds average blood pressure, blood flow to brain stops

Increasing intracranial pressure can force brain downward into spinal canal, crushing it.


Assessment of head injury:

Vital signs:
body responds to increasing intracranial pressure by raising BP
Increased BP moves blood into brain against rising ICP
Heart rate falls in response to rising BP

Other indicators of increased ICP
Vomiting (often projectile)

LoC is best indicator of Pt's condition:


Cushing's triad

Increased BP
Altered Breathing
Slow Pulse


Brain injury classification using GCS

SEVERE 8 but



Isolated head injury does not cause hypotension or tachycardia

Signs of shock in head injured Pt indicate other injuries are present.


management of:
Head Injury

Consider early call for help: paramedic/HEMS/BASIC
ABC's with c-spine control is it time critical? if yes A or B = GO!!
Ensure adequate oxygen and airway management
Dress open wounds
Appropriate immobilisation: collar, orthopaedic stretcher, head blocks, straps
Follow major trauma decision tool guidelines

Any patient with significant head injury HAS a neck injury until proven otherwise


considerations for head injured pt on anti-coagulant's

Head injured pt's on anti-coagulants should be conveyed to and ED regardless of apparent severity

Require CT head scan within 8 hours of injury.


head injury management DO NOT'S

Do not apply pressure to open or depressed skull fractures

Do Not attempt to stop flow of blood or CSF from nose or ears

Do Not remove penetrating objects

Do Not spend extended time ONS

Do Not forget C-Spine!!!