Management of Head Injury

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INTRODUCTION
The clinical scenario given is a serious one. Therefore, extreme care and caution will be required in assessing the patient and managing any injuries discovered in the process. In this essay, the potential clinical problems the patient could have would be explores, and based on the clinical parameters provided, attempt would be made to interpret and subsequently manage the signs, symptoms as well as the injuries presented by the patient. In order to identify quality diagnostic methods, recommendations and evidenced-based management plan, search and review of existing guidelines addressing traumatic head injury was carried out. Also Current books and texts that was relevant to traumatic brain injuries which also included recommendations for the care of the individuals specifically at pre-hospital level was studied. The search was conducted using bibliographic data bases such as, The Chochrane Library, National Guidelines, Medline, Cinhal and so on. Key search words such as ‘Management of traumatic head injury at pre-hospital setting’ and so on were used to extract the most relevant information from these sources. Potential Injuries

The mechanism of injury (moi) seems to suggest a number of possible acute head injuries, Doland and Holt, (2000) for example blunt trauma to the head with potential contusion around the region of impact Johnson et al. (2005). Contusion in the head commonly indicates a degree of bleeding beneath the skull layer Li et al. (2009) and in this case, external bleeding is not ruled out. The other potential injuries include cranial indentation, intracranial lesion and possible skull fracture Silvestri and Aronson, (1997). The aetiology of these injuries depends on the force of impact of the accelerating or decelerating cricket ball, Sanders et al. (2010). Furthermore, the relationship between skull fracture and raised intracranial pressure following traumatic head injury has been widely investigated by Matthew et al. (2007). The conclusion of their empirical studies was a direct correlation. Consequently, there is a risk of raised intra cranial pressure, (ICP) in this patient. McMillian and Roger, (2009) result also corroborates Gregory and Ward, (2010) which list head trauma as one of the causes of ICP. In this scenario, the aetiology would be that the force of impacting ball compromised the protective layer of the delicate brain organs (cerebral cortex, cerebellum and the brain stem) Sanders, et al. (2010) this may rupture, lacerate or burst blood vessels in any of these brain organ Li, et al. (2009). This situation potentially could lead to increase in extrastitial fluid contents of the brain with little or insufficient outlet causing a fatal rise in ICP Clifton, (1990). Another important potential injury this patient might present is cervical spine (c-spine) injury Gregory and Ward (2010). A large and growing body of literatures Matthew, et al. (2007), Pickering, et al. (2011) and Sollid, et al. (2009) have all independently investigated the association of c-spine injury and blunt head trauma. Their conclusions suggest direct relationship. In Bethel, (2012) study, blunt or penetrating trauma to the head was discussed as a causative factor to Contrecoup injury. According to McGraw- Hill (2002: p.89) medical dictionary, contrecoup injury “is a brain bruise diametrically opposite the site of an impacting blow to the cranium”. It is probable that he could incur contrecoup injury. In addition to this, Anyebe, et al. (2008) linked the potential for simultaneous cause of other internal brain injuries along with contrecoup, these includes, cerebral contusion, cerebral oedema, intra- cerebral haemorrhage, extradural haematoma, subdural haematoma, epidural haematoma, and any or all these would be suspected in this patient. The paramedic would also consider the likely-hood of secondary injuries Matthew, et al. (2007). One of such consideration would be the advent of Cushings triad; a set...
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