Head Injury

Head Injury

50% of deaths in vehicular trauma are associated with head injury

Mechanism of injury will often provide guidance regarding the likelihood of serious intracranial pathology

Assessment of head injuries

Assessment of vital signs Airway, Breathing,Circulation

Mini neurological examination to assess pupilary function and lateralised extremity weakness

Assessment of conscious level
(AVPU or GCS)

AVPU Score

A = Alert

V = Responding to voice

P = Responding to pain

U = Unconscious

Glasgow Coma Score

Eye opening.

Spontaneous 4

To speech 3

To pain 2

None 1

Best motor response

Obeys 6

Localizes 5

Withdraws 4

Abnormal flexion 3

Extensor 2

None 1

Verbal response

Orientated 5

Confused 4

Inappropriate 3

Incomprehensible 2

None 1

GCS 8 or less = severe head injury

GCS 9 - 12 = Moderate head injury

GCS 13 - 15 = Minor head injury

Mechanisms of brain damage in head injury

Diffuse damage:- bruising of the brain

Focal impact damage

Intracranial bleeding

Hypoxia/ischaemia:- inadequate oxygen delivery due to ventilation failure or shock

Emergency management of head injury

Maintain oxygen and glucose delivery to the brain by -
Airway, Breathing, Circulation

Reduce intracranial pressure by - Sedation and artificial ventilation, Fluid control (prevent overhydration).

Causes of deteriorating conscious level following head injury

Hypoxia - lack of oxygen

Ischaemia - lack of blood flow

Bleeding into the brain

Fits following brain damage

Other manifestations of head injury

Restlessness

Hyperthermia

Fits

Likelihood of requiring surgery in head injury

Low risk

Asymptomatic, Headache (mild), Dizziness,Absence of moderate/high risk criteria

Moderate risk

Change of consciousness, Progressive headache, Siezure, Vomiting, Amnesia, Facial injury, Skull fracture

High risk

Depressed/decreasing consciousness, Focal signs, Penetrating injury, Palpable depressed fracture

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