Post on 05-Dec-2014
description
HEAD INJURY
AND TRUMATIC
BRAIN INJURY
Dr.Mansoor KhanMBBS, FCPS-I,Resident SCW, KTH, Peshawar
Mar14th, 2009
“Traumatic Brain Injury is an insult to the brain caused by an
external physical force”
TBI
CLOSED HEADINJURY
OPEN HEADINJURY
No obvious external signs, resulting from –motor vehicle crashes, falls, child abuse, or domestic violence, child violence..
Obvious external woundFor example a gunshot wound or object penetrating the skull.
Highest among adolescents, young adults, and those older than 75
Vehicle crashes are the leading cause of brain injury. Falls are the
second leading cause
50% of major trauma deaths are due to TBI
Motor Vehicle Crashes Crashes- 44%Falls - 26%
Other/Unknown - 13%Non-Firearm Assaults Assaults- 9%
Firearms Firearms- 8%
These days there is a new category of Head injury ––
BLAST INJURY!
How grave are the conditions!!!!!!!!
The Annual cost of TBI to the U.S.is equal to one of these
$60.0 Billion!!
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TYPES OF HEAD INJURY
CONTUSIONS
EXTR-DURALHEMATOMA
SUB-DURALHEMATOMA
DIFFUSE AXONAL INJURY
INTRA-CEREBRALHEMORRHAGE
SUB-ARACHNOIDHEMORRHAGE
BLEEDING
LACERATIONSSecure ABC
Expose, clean, apply pressure dressing if bleeding
When the brain suddenly shifts When the brain suddenly shifts inside the skull and knocks against inside the skull and knocks against
the skulls bony surface. the skulls bony surface. Concussions can last from a few Concussions can last from a few
moments, to an unconscious state moments, to an unconscious state for over 3 minutes.for over 3 minutes.
CONCUSSION
Grade 1 Grade 2 Grade 3Allow casualty to rest, however continually monitor in case their condition changes. Lay casualty down with their head and shoulders slightly raised
Seek professional medical assistance, lay the casualty down with the head and shoulders slightly raised. Try to keep casualty awake and talking
Call an ambulance immediately, lay casualty down with head and shoulders slightly raised, try to keep them awake and talking. If casualty falls unconscious and is not breathing, commence CPR and monitor vital signs
Grade 1 – conscious, symptoms last under 15 minutesGrade 1 – conscious, symptoms last under 15 minutesGrade 2 – conscious, symptoms last over 15 minutes Grade 2 – conscious, symptoms last over 15 minutes Grade 3 - unconsciousGrade 3 - unconscious
CONCUSSION
Skull
Contusion, or bruising of the brain
may occur at the site
of the blow.
Brain
Area of bruising
Site of impact
POSSIBLE SITE OF BRAIN INJURY FOLLOWING A BLOW TO BACK OF HEAD
BRAIN CONTUSIONS
Conduct Primary SurveyConduct Primary Survey
If symptoms indicate severe If symptoms indicate severe head trauma, call ambulancehead trauma, call ambulance
Monitor casualty’s level Monitor casualty’s level of consciousnessof consciousnessIf casualty falls unconsciousIf casualty falls unconsciousand breathing ceases, commence and breathing ceases, commence CPR until further help arrivesCPR until further help arrives
BRAIN CONTUSION
EXTR-DURAL HEMATOMA
Blow to the temporal, parietal boneRupture of the middle meningial artey
Initial concussion followed by lucid interval
Respects the suture lines.Seen on CT Brain as lens-shaped blood collectionwith a convex medialborder .
Carries a 5% to 20% mortality rate
Severe head injury-Sudden deceleration injuries
Rupture of a bridging vein
Thin layer of blood in the subdural space
Crescent-shaped blood collectionswith a concave medial border. This does not resect the suture lines. Note also midline shift.
SUB-DURAL HEMATOMA
SUB-ARACHNOID HEMORRHAGE
Bleeding occurs between the arachnoid and pia mater
Increased attenuationis seen in the CSF spacesover the cerebralhemispheres
INTRA-CEREBRAL HEMORRHAGE
Injury of the brain substance itselfAssociated with cerebral laceration,
contusion, oedema and necrosisEvacuation of the clots can have poor
resultsNot as easy to remedy.
DIFFUSE AXONAL INJURY
Occurs due to shearing forces between grey and white matter.
Generalized cerebral oedema results due to parenchymal disruption leadsing
to an increase in ICPRanges from mild form-concussion
severe form- persistent vegetative state
Glasgow coma scale
Fully conscious (GCS 15)
Confused (GCS 9-14)
Comatose (GCS 3-8)
Mild Head injury. GCS 13 – 15 80%
Moderate Head injury GCS 9 – 12 10%
Severe Head injury GCS < 9 10%
GCS<13 at any point
GCS 13-14 at 20
Focal deficit
? Open/depressed/Basal #
Post-traumatic seizure
> 1 vomiting episode
LoC or ante grade amnesia
No imaging now
CT within 1hr
+ Get help!
-When to do CT- Scan
Age 65
Coagulopathy/warfarin
+
+
Dangerous Mex: pedestrian rta, ejection, fall > 1m / 5stairs.
Retrograde amnesia>30mins
-
--
CT within 8hrs
+
Deep cuts or tears to the scalpNauseaVomiting
Severe headacheVisual disturbance
Drowsiness or difficulty being arousedUnequal sized pupils, or pupils that do not
respond to lightParalysis, numbness or loss of function over
one half of the bodyProblems with balance
Fluid flowing from eyes and/or mouthDrunken behaviour
Fits, confusion or unconsciousness
PRESENTATION
Intense headache, worse when lying flat and/or with physical exertion
Unequal or dilated pupilsVomiting
Weakness on one side of the bodyNoisy, irregular breathing
Irritable or aggressive behaviour
INCREASED
ICP
Sedate and intubateNurse patient at 30 degree angle-aids
venous drainageMild hyperventilation- keep pCO2
approx 4.5kPa- if allowed to fall lower this leads to vasoconstriction and
subsequent ischaemiaMild hypothermia
INCREASED
ICP
INCREASED
ICP
Surgical management
Burr holesEvacuation of mass lesion +/-
craniectomyDecompressive craniectomy
THANKS