Treat a Casualty with a Closed Head Injury

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Treat a Casualty with a Closed Head Injury
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Introduction

• Most common for individuals working in hazardous
  environments
• Delicate structures demand diligence in the care
  of injured and damaged sensory organs
• Underlying structures may also be damaged
• Cranium
• Brain
• Trachea
• Neck vessels
• Cervical spine

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Anatomy and Physiology of the Head

• Scalp
• Skull (cranium)
• Brain

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Anatomy and Physiology of the Head
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Initial Assessment

• General Impression
• Assess Airway
• Assess Breathing
• Assess circulation

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Rapid Trauma Assessment

• Look for obvious deformities
• Depressed Skull Fractures
• Lacerations
• All head injuries must be treated as if cervical
  spine involvement
• Bleeding from ears and nose
• Clear fluid from ears and nose
• Swelling/discoloration behind ears
• Swelling/discoloration around both eyes
• Assess pupils

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Open Head Wound
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Can the patient feel you touching his fingers and
toes?
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Neurological Exam

• Assess Neurologic status using the Glascow Coma
  Scale (GCS)
• Severe head injury GCS is lt 9
• Moderate head injury GCS is 9 to 12
• Minor head injury GCS is 13 to 15

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Glasgow Coma Scale
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Glasgow Coma Scale
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Nasal Injuries

• Signs and symptoms
• Special considerations
• Abrasions, lacerations, and punctures
• Avulsion
• Fully avulsed flaps of skin
• Septum Devaited

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Nasal Injuries
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Nasal Injuries

• Foreign objects
• Fully immobilize the spine
• Monitor vital signs, airway, and LOC
• Transport in a sitting position

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Nasal Injuries

• Nosebleeds (epistaxis)
• No signs or symptoms of skull fracture or spinal
  injury
• Conscious patient, place in a slightly forward,
  seated position to allow for drainage.
• Unconscious patient or if signs and symptoms of
  spinal injury are present, place on long spine
  board in recovery position.

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Nasal Injuries
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Oral Cavity Injuries

• Signs and symptoms
• Lacerated lip or gum
• Lacerated or avulsed tongue
• Dislodged teeth

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Airway Obstruction
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Lacerated or Avulsed Tongue
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Head Injuries

• Scalp wounds
• Skull injuries
• Linear nondisplaced fractures, compound
  fractures, or depressed fractures
• Large contusion or darkened swelling of scalp
• Brain Injury

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Concussion

• Implication that there is no significant injury
  to the brain
• Trauma to the head with a variable period of
  unconsciousness or confusion and then a return to
  normal consciousness

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Concussion
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Cerebral Contusion

• Bruised brain tissue
• History of prolonged unconsciousness or serious
  alteration in state of consciousness
• Brain swelling may be severe and rapid
• Question CVA
• Personality Changes
• Altered LOC

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Contusion
Side of Impact
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Intracranial Hemorrhage

• Three major types
• Epidural hematoma
• Subdural hematoma
• Intracranial hematoma
• Signs and symptoms
• Change in level of consciousness
• headache
• Decreased pulse rate
• Increased blood pressure
• Change in pupil size and reaction

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Treatment of Brain Injuries
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Treatment of Brain Injuries

• Manage IV fluids, as indicated
• Assess for shock
• Apply a dressing/bandage being careful not to
  compromise the airway

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Treatment of Brain Injuries

• If brain tissue is exposed, apply a sterile
  dressing. Local protocol dictates moist or dry
  sterile dressing.
• Administer high flow Oxygen
• Reassess neurologic status and vitals
• Stabilize impaled object
• Support with suction of secretions as needed if
  available
• Administer wound care

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Treatment of Brain Injuries

• Administer pain control as needed
• Full spinal immobilization
• Transport in head raised position by elevating
  the top of the litter or spinal board.
• Raise head of bed 30 degrees

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Summary

• Anatomy of the head and central nervous system
• Rapid assessment
• Treatment of decreased level of consciousness
• Rapid Transport
• Frequent reassessment