Head Injury Psychological Services San Antonio Police Department

1. Head Injury Psychological Services San Antonio Police Department

3. Degree of Head Injuries • Mild • Moderate • Severe • Catastrophic • Determination is based upon loss of consciousness, PTA, and Glasgow coma scale

4. Types of Brain Injuries Focal vs. Diffused -- Focal: Stroke, aneurism, penetration of skull -- Diffuse: -- Open vs. Closed -- Open: More acute trauma -- Closed: Higher risk of brain swelling

5. Mild Brain Injury • Seventy-five percent of all brain injuries are in this category • No loss of consciousness or loss of consciousness for less than 15 minutes • A dazed vacant stare right after the injury • Delayed motor response to questions like touch you nose • Disorientation and foggy memory • A normal CT scan

6. Mild Brain Injury • Physical symptoms • Fatigue • Sensitivity to light and noise • Numbness or tingling in hands and feet • Ringing in ears or tinnitus • Headaches • Dizziness

7. Mild Brain Injury • Cognitive • Difficulty concentrating • Increased distractibility • Difficulty reading • Problems with attention and concentration

8. Mild Brain Injury • Mood • Depression • Anxiety • Mood swings • Sleep disturbance • Irritability • Loss of libido

9. Moderate Brain Injury • Unconscious from 15 minutes to 24 hours • Balance problems or tremors • Seizures • Memory deficits • Poor judgment and difficult with problem solving • Lack of coordination

10. Moderate Brain injury • Paralysis • Language problems • Perceptual difficulties • Behavioral problems

11. Severe Brain Injury/Catastrophic Brain Injury • Severe Brain Injury • Loss of consciousness for more than 24 hours • Initially significant cognitive and motor problems • Many of these individuals remain under care and supervision of others for long periods of time • Catastrophic Brain injury • May remain in coma for months, or years • Sometimes referred to as a “persistent vegetative state”

12. Who To Refer Anyone exposed to or involved in a blast, fall, vehicle crash, or direct impact who becomes dazed, confused or loses consciousness, even momentarily, should be further evaluated for a brain injury.

13. Red Flags • Refer for immediate medical evaluation if any of the following are present: -- Double vision -- Seizures -- Breathing difficulties -- Slurred speech -- Headache that worsens -- Unsteady on feet -- Disorientation -- Repeated vomiting -- Cannot be awakened easily -- Weakness/numbness -- Unusual behavior or confusion/irritability

14. Longer-term Symptoms Impaired balance/motor functioning Postural instability Attention/concentration deficits Memory problems Slowed processing speed Slowed reaction time Impaired executive functioning Higher risk for subsequent concussion for at least the next year

15. Post Concussion Syndrome • PCS criteria in DSM-IV-TR • History of head trauma • Difficulty with attention or memory • 3 or more of the following symptoms, which are present for at least 3 months -- Easily fatigued -- Disordered sleep -- Headache -- Vertigo/dizziness -- Irritability/aggression -- Anxiety/depression -- Changes in personality -- Apathy

16. Management of Brain Injured Individuals • Remain calm • Regulate your voice • Keep communications short simple • One command at a time may need to repeat commends • If possible explain what you are going to do before you act no surprises • Avoid using bright lights reduce noise • One officer give directions • Ask about medications, caretakers, medical personnel • Redirect their attention

17. Questions??