‫محاضرة الحادي عشر‬

Head injury ‫قسم االسعاف – تمريض‬

‫الطوارئ‬
‫استاذ المحاضر بختيار محمد‬
‫احمد‬
Head injuries are one of the most common causes of disability and
death in adults. The injury can be as mild as a bump, bruise
(contusion), or cut on the head, or can be moderate to severe in
nature due to a concussion, deep cut or open wound, fractured skull
bone(s), or from internal bleeding and damage to the brain.

Types of head injury?

 Concussion. A concussion is an injury to the head area that
may cause instant loss of awareness or alertness for a few
minutes up to a few hours after the traumatic event.

 Skull fracture. A skull fracture is a break in the skull bone.

There are four major types of skull fractures. including the
following:

A- Linear skull fractures. This is the most common type

of skull fracture. In a linear fracture, there is a break in
the bone, but it does not move the bone. These patients
may be observed in the hospital for a brief amount of
time, and can usually resume normal activities in a few
days. Usually, no interventions are necessary.

B- Depressed skull fractures. This type of fracture may

be seen with or without a cut in the scalp. In this fracture,
part of the skull is actually sunken in from the trauma.
This type of skull fracture may require surgical
intervention, depending on the severity, to help correct
the deformity.

C-Diastatic skull fractures. These are fractures that occur

along the suture lines in the skull. The sutures are the
areas between the bones in the head that fuse when we
are children. In this type of fracture, the normal suture
 lines are widened. These fractures are more often seen in
newborns and older infants.

D-Basilar skull fracture. This is the most serious type of

skull fracture, and involves a break in the bone at the
base of the skull. Patients with this type of fracture
frequently have bruises around their eyes and a bruise
behind their ear. They may also have clear fluid draining
from their nose or ears due to a tear in part of the
covering of the brain. These patients usually require close
observation in the hospital.

 Intracranial hematoma (ICH). There are several types of

ICH, or blood clots, in or around the brain. The different types
are classified by their location in the brain. These can range
from mild head injuries to quite serious and potentially life-
threatening injuries. The different types of ICH include the
following:

A-Epidural hematoma. Epidural hematomas occur when a

blood clot forms underneath the skull, but on top of the
dura, the tough covering that surrounds the brain. They
usually come from a tear in an artery that runs just under
the skull called the middle meningeal artery. Epidural
hematomas are usually associated with a skull fracture.

B- Subdural hematoma. Subdural hematomas occur when a

blood clot forms underneath the skull and underneath the
dura, but outside of the brain. These can form from a tear
in the veins that go from the brain to the dura, or from a
cut on the brain itself. They are sometimes, but not
always, associated with a skull fracture.

C-Contusion or intracerebral hematoma. A contusion is a

bruise to the brain itself. A contusion causes bleeding and
swelling inside of the brain around the area where the
head was struck. Contusions may occur with skull
fractures or other blood clots such as a subdural or
 epidural hematoma. Bleeding that occurs inside the brain
itself (also called intraparenchymal hemorrhage) can
sometimes occur spontaneously. When trauma is not the
cause, the most common causes are long-standing, high
blood pressure in older adults, bleeding disorders in
either children or adults, or the use of medications that
cause blood thinning or certain illicit drugs.

D-Diffuse axonal injury (DAI). These injuries are fairly

common and are usually caused by shaking of the brain
back and forth, which can happen in car accidents, from
falls or shaken baby syndrome. Diffuse injuries can be
mild, such as with a concussion, or may be very severe, as
in diffuse axonal injury (DAI). In DAI, the patient is
usually in a coma for a prolonged period of time, with
injury to many different parts of the brain.

What causes a head injury?

There are many causes of head injury in children and adults. The
most common traumatic injuries are from motor vehicle accidents
(automobiles, motorcycles, or struck as a pedestrian), from violence,
from falls, or as a result of child abuse. Subdural hematomas and
brain hemorrhages (called intraparenchymal hemorrhages) can
sometimes happen spontaneously.

Symptoms of a head injury?

 Mild head injury:
 Raised, swollen area from a bump or a bruise
 Small, superficial (shallow) cut in the scalp
 Headache
 Sensitivity to noise and light
 Irritability
 Confusion
 Lightheadedness and/or dizziness
 Problems with balance
 Nausea
 Problems with memory and/or concentration
 Change in sleep patterns
  Blurred vision
 "Tired" eyes
 Ringing in the ears (tinnitus)
 Alteration in taste
 Fatigue or lethargy

 Moderate to severe head injury (requires immediate

medical attention)--symptoms may include any of the
above plus:
 Loss of consciousness
 Severe headache that does not go away
 Repeated nausea and vomiting
 Loss of short-term memory, such as difficulty remembering the
events that led right up to and through the traumatic event
 Slurred speech
 Difficulty with walking
 Weakness in one side or area of the body
 Sweating
 Pale skin color
 Seizures or convulsions
 Behavior changes including irritability
 Blood or clear fluid draining from the ears or nose
 Deep cut or laceration in the scalp
 Open wound in the head
 Foreign object penetrating the head
 Coma (a state of unconsciousness from which a person cannot be
awakened; responds only minimally, if at all, to stimuli; and
exhibits no voluntary activities)

Diagnostic tests may include:

 Blood tests
 X-ray. A diagnostic test that uses invisible electromagnetic energy
beams to produce images of internal tissues, bones, and organs onto
film.
 Computed tomography scan (also called a CT or CAT scan). A
diagnostic imaging procedure that uses a combination of X-rays and
computer technology to produce horizontal, or axial, images (often
called slices) of the body. A CT scan shows detailed images of any part
of the body, including the bones, muscles, fat, and organs. CT scans are
more detailed than general X-rays.
  Electroencephalogram (EEG). A procedure that records the brain's
continuous, electrical activity by means of electrodes attached to the
scalp.
 Magnetic resonance imaging (MRI). A diagnostic procedure that uses a
combination of large magnets, radiofrequencies, and a computer to
produce detailed images of organs and structures within the body.

Treatment of a head injury

Specific treatment of a head injury will be determined by
your doctor based on:
 Your age, overall health, and medical history
 Extent of the head injury
 Type of head injury
 Your tolerance for specific medications, procedures, or therapies
 Expectations for the course of the head injury
 Your opinion or preference

Depending on the severity of the injury, treatment may include:

 Ice
 Rest
 Topical antibiotic ointment and adhesive bandage
 Observation
 Immediate medical attention
 Stitches
 Hospitalization for observation
 Moderate sedation or assistance with breathing that would require
being placed on a breathing machine, or mechanical ventilator or
respirator
 Surgery