Any trauma to the scalp, skull or brain, TBI. Head trauma includes an alteration in consciousness, no matter how brief.
Common causes: motor vehicle crashes and falls. Firearm, assaults, sports-related injuries, recreational accidents.
Deaths occur at three points in time after injury: 1) Immediately 2) within 2 hours 3) 3 weeks after the injury
GCS on arrival is also a strong predictor of survival: GCS < 8 30% to 70% chance of survival. GCS > 8 indicating >90% survival.
Neurological assessment findings of head injury:
Lacerations or bruises on head
Disoriented, confused depressed LOC
GCS: move eyes, respond verbally, follow a motor command
Sluggish or unequal pupil (ipsilateral)
Respiratory changes, < O2 saturation
Involuntary, absent movement
Skull fractures Linear or depresses
Simple or compound
Closed or open
Location of fracture determines manifestations
Basilar (skull base): Facial paralysis, Raccoon eyes (periorbital edem and ecchymosis), Battle’s sign (postauricular ecchymosis), dural tear: otorrhea (CSF leakage out of the ear), rhinorrhea ( CSF leackage out of the nose), halo or ring sign (red blood surrounded by cerebrospinal fluid).
Head injuries – diffuse or focal
Diffuse: Concussion – a sudden transient mechanical head injury with disruption of neural activity and a change in the LOC – considered a minor head injury. Pt may or may not lose total consciousness. S/s – brief disruption in LOC, amnesia regarding the event (retrograde), and headache. Postconcussion syndrome – two weeks to two months after injury. Persistent headache, lethargy, personality and behavioral changes, shortened attention span, decreased short-term memory, and changes in intellectual ability.
Contusion – bruising of the brain tissue within a focal area. Usually associated with a closed head injury. May contain areas of hemorrhage, infarction, necrosis and edema at fracture site. Coup-contrecoup injury –