This document defines and discusses head injuries. It notes that in the US there are 500,000 new head injury cases annually, with 10% dying before reaching the hospital. Head injuries are classified based on their mechanism, severity using the GCS score, morphology, and whether they are primary or secondary injuries. The anatomy of the head and mechanisms of secondary injuries like hematomas are described. Management involves thorough history, physical exam, imaging studies, and specific treatments depending on injury type and severity ranging from observation to surgery.
3. INCIDENCE
• In the USA, 500,000 new cases
• 10% die before hospital.
• 10% are severe.
• 10% are moderate.
• 80% are mild.
• Many deaths and comorbidities can be
reduced through prompt referral .
4. ANATOMY
• Scalp- five layers: skin, connective tissue,
aponeurosis ,loose areolar tissue and
pericranium
• skull: cranial vault- smooth, some areas thin.
pterion
cranial base is irregular- anterio and
middle cranial fossa
• Meninges: three layers. Dura mater,arachnoid
and pia.
• Brain –specific functions
5. ANATOMY(cont)
• Cerebrospinal fluid-30ml per hour, from
choroid plexus
• Tentorium- supra and infratentorial
compartments .Tentorial incisura edge
closely related to third cranial nerve and
uncus
6. PHYSIOLOGY
• Intracranial pressure –normal 10mmHg or 136
mm water.
Above 20mmhg is abnormal
• Monroe Kellie doctrine -brain+blood +csf is a
constant. Initial compensation, eventually
exponential rise.
• Cerebral perfusion CPP=MAP-ICP. Perfusion
pressure of <70mmhg is critical
• Cerebral perfusion –normal is 50ml/100g of
brain
7. CLASSIFICATION
• Mechanism of injury- blunt or penetrating
• Severity of injury-GCS
• Morphology of injury- skull or
intraparenchymal
• Primary or secondary
12. PRIMARY SURVEY
• A.-ABCDE
• B-Immobilize and stabilize the cervical
spine
• C-Perform a brief neurological exam
1.pupillary response.
2.GCScore
determination.
13. SECONDARY SURVEY
• A-.Inspect the entire head. Remove dressings ,look for
lacerations or csf
• B-Palpate for fractures including the wounds
• C-Inspect all scalp lacerations-look out for
brain,depressed fractures,debris or csf
• D-Minineurological examination--GCS -BEST
- -Eye
-Motor
- - Verbal
Pupillary
response
E-Examine cervical spine
F-Determine the extend of the injury
G-Regular reassessment
15. SPECIFIC MANAGEMENT
• MILD HEAD INJURY-GCS 14 or 15
-Approx 80% of pts in A &E have mild HI
-majority recover fully
-3% deteriorate suddenly
-ideally, all with long period of loc should
have a CT scan
-ideally
admit for observation for 24 hours
-advise to come back in case of any
warning signs
16. MODERATE HEAD INJURY
• GCS 9-13
• Approx 10 % of patients in A&E departm
• May have focal signs.
• 10-20% may deteriorate
• Up to 40% have abnormal scans
• Admit even if CTscan is normal
17. SEVERE HEAD INJURY
• GCS 3-8
• Cannot follow commands
• Up to 30% are hypoxaemic-
• 13% hypotensive
• 12% anaemic
• Combination of hypoxia and hypotension
leads up to 75% mortality.
• Admit all and protect airway from early
