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Head Injuries

Head Injuries. 1,000,000+ patients a year in A&E ~5000 die Biggest killer for 15-24’s. Head Injuries. Falls Sports injuries Fights RTCs Get info: When? How fast? How high?. Head Injury causes. Skull fracture Concussion Compression NB may have spinal injury. What can go wrong?.

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Head Injuries

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  1. Head Injuries

  2. 1,000,000+ patients a year in A&E • ~5000 die • Biggest killer for 15-24’s Head Injuries

  3. Falls • Sports injuries • Fights • RTCs • Get info: • When? • How fast? • How high? Head Injury causes

  4. Skull fracture • Concussion • Compression • NB may have spinal injury What can go wrong?

  5. Shaking of the brain • Temporary loss of function (‘stunned’) • (Usually) no long term damage • Symptoms…? Concussion

  6. Headache (mild) • Dizziness • Nausea • Confusion • Loss of memory • Loss of conciousness • Visual disturbances Concussion: Symptoms

  7. Bleeding or swelling = increased pressure (BUT no where to go!) • May occur straight after injury • …OR days after! • (so always ask about recent head injuries) • Symptoms? Compression

  8. Deteriorating level of response (AVPU) • Intense headache • Nausea / vomiting • Noisy breathing becoming shallow • Slow, strong pulse • One-sided weakness / paralysis • Drowsiness • Change in personality • Severe amnesia • Posturing • Unequal pupils (NB late sign!) • Seizures • Lucid intervals Compression: Symptoms

  9. Spinal injury v likely (head is heavy) • C3-5 keep the diaphragm alive • Have a feel • Pain or tenderness = immobilise!! C-spine!

  10. Danger (fights etc) • Response (AVPU) • Airway • C-Spine!! • Recovery position? • Breathing • Circulation • Event history – when depends on seriousness of Pt 999? So...what do you do?: Primary Survey

  11. Airway is the most important thing • If unconscious, needs to be opened. • Head tilt / chin lift ? • If C-spine is damaged, we can use the jaw thrust • (BUT…what if they vomit?) So...what do you do?: Airway

  12. Feel the scalp – deformity / swelling / bleeding? • Check for CSF fluid • Take the pulse • SAMPLE (inc. alcohol & drugs) • Level of orientation (place, time, event, person) • (But don’t take the piss) What else?Assessment NB – Complicated by alcohol

  13. C-spine? (Jaw thrust?) • Position (sat up? Recovpos?) • HCP? Hospital? 999? • Sort wounds (inspect fist!) • Head injury advice (next slide) • Advise not to drink / get high • Advise not to ‘get back on the pitch’ • Advise they’re watched by a friend (why?) Management • And more OBS!

  14.  drowsiness • Worsening headache • Confusion & memory loss • Behaviour changes • One-sided weakness • Dizziness • Visual disturbances • Bleeding / CSF • Breathing problems • Vomiting • ..Well.. bad stuff. Namely: Look out for… • NOTE – do they have CAPACITY?? Do they understand what’s going on? Can they remember & repeat the information?

  15. Head injury (with casualty) • Conscious neck injury • Unconscious spinal injury Scenarios

  16. http://www.nhs.uk/Conditions/Head-injury-minor/Pages/Treatment.aspxhttp://www.nhs.uk/Conditions/Head-injury-minor/Pages/Treatment.aspx • http://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/prehospitalcare/jrcalcstakeholderwebsite/guidelines/head_trauma_2006.pdf Sources

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