Head Injury

Head Injury

• Any trauma to the scalp, skull, or brain

Setiap
Setiap trauma pada kulit kepala, tengkorak, atau otak
otak
• Head trauma includes an alteration in
consciousness no matter how brief
Trauma
Trauma kepala
kepala termasuk
termasuk perubahan
perubahan kesadaran tidak peduli
peduli seberapa
seberapa
singkat
 Head Injury

• Causes
– Penyebab
– Kecelakaan kendaraan bermotor
– Cedera yang berhubungan dengan senjata api
– Air terjun
– Assaults
– Cedera terkait olahraga
– Kecelakaan rekreasi
 Head Injury

• Potensi tinggi untuk hasil yang buruk

• Kematian terjadi pada tiga titik waktu
setelah cedera:
– Segera setelah cedera
– Dalam 2 jam setelah cedera
– 3 minggu setelah cedera
 Head Injury
Types of Head Injuries

• Laserasi kulit kepala

– Jenis trauma kepala yang paling ringan
– Kulit kepala adalah pendarahan yang sangat
vaskular
– Komplikasi utama adalah infeksi
 Head Injury
Types of Head Injuries

• Skull fractures
– Linear or depressed
– Simple, comminuted, or compound
– Closed or open
– Direct & Indirect
– Coup & Contrecoup
 Head Injury
Types of Head Injuries

• Skull fractures
– Location of fracture alters the
presentation of the manifestations
– Facial paralysis
– Conjugate deviation of gaze
– Battle’s sign
 Head Injury
Types of Head Injuries

• Basal Skull fractures

– CSF leak (extravasation) into ear (Otorrhea)
or nose (Rhinorrhea)
– High risk infection or meningitis
– “HALO Sign (Battle Sign)” on clothes of
linen
– Possible injury to Internal carotid artery
– Permanent CSF leaks possible
Battle’s Sign

Fig. 55-13
 Nursing Care of Skull
Fractures

• Minimize CSF leak

– Bed
Bed flat
flat
– Never
Never suction
suction orally;
orally; never
never insert
insert NG
NG tube;
tube; never
never use
use Q-Tips
Q-Tips
in
in nose/ears;
nose/ears; caution
caution patient
patient not
not to blow nose

• Place sterile gauze/cotton ball around area

• Verify CSK leak:

– DEXTROSTIX:
DEXTROSTIX: positive
positive for
for glucose
glucose

• Monitor closely: Respiratory status+++

 Head Injury
Types of Head Injuries

• Minor head trauma

– Concussion
• A sudden transient mechanical head
injury with disruption of neural activity
and a change in LOC
• Brief disruption in LOC
• Amnesia
• Headache
• Short duration
 Head Injury
Types of Head Injuries

• Minor head trauma

– Postconcussion syndrome
• 2 weeks to 2 months
• Persistent headache
• Lethargy
• Personality and behavior changes
 Head Injury
Types of Head Injuries

• Major head trauma

– Includes cerebral contusions and
lacerations
– Both injuries represent severe trauma
to the brain
 Head Injury
Types of Head Injuries

• Major head trauma

– Contusion
• The bruising of brain tissue within a focal
area that maintains the integrity of the pia
mater and arachnoid layers
– Lacerations
• Involve actual tearing of the brain tissue
• Intracerebral hemorrhage is generally
associated with cerebral laceration
 Head Injury
Pathophysiology

• Diffuse axonal injury (DAI)

– Widespread axonal damage occurring
after a mild, moderate, or severe TBI
– Process takes approximately 12-24
hours
 Head Injury
Pathophysiology

• Diffuse axonal injury (DAI)

– Clinical signs:
 LOC
 ICP
• Decerebration or decortication
• Global cerebral edema
 Head Injury
Complications

• Epidural hematoma
– Results from bleeding between the
dura and the inner surface of the skull
– A neurologic emergency
– Venous or arterial origin
 Head Injury
Complications

• Subdural hematoma
– Occurs from bleeding between the
dura mater and arachnoid layer of the
meningeal covering of the brain
 Epidural and Subdural Hematomas

Epidural Hematoma

Subdural Hematoma

Fig. 55-15
 Head Injury
Complications

• Subdural hematoma
– Usually venous in origin
– Much slower to develop into a mass
large enough to produce symptoms
– May be caused by an arterial
hemorrhage
 Head Injury
Complications

• Subdural hematoma
– Acute subdural hematoma
• High mortality
• Signs within 48 hours of the injury
• Associated with major trauma (Shearing
Forces)
• Patient appears drowsy and confused
• Pupils dilate and become fixed
 Head Injury
Complications

• Subdural hematoma
– Subacute subdural hematoma
• Occurs within 2-14 days of the
injury
• Failure to regain consciousness may
be an indicator
 Head Injury
Complications

• Subdural hematoma
– Chronic subdural hematoma
• Develops over weeks or months after
a seemingly minor head injury
 Head Injury
Diagnostic Studies and
Collaborative Care
• CT scan considered the best diagnostic test to
determine craniocerebral trauma
• MRI
• Cervical spine x-ray
• Glasgow Coma Scale (GCS)
• Craniotomy
• Craniectomy
• Cranioplasty
• Burr-hole
 Head Injury
Nursing Management
Nursing Assessment

– GCS score
– Neurologic status
– Presence of CSF leak
 Head Injury
Nursing Management
Nursing Diagnoses

– Ineffective tissue perfusion

– Hyperthermia
– Acute pain
– Anxiety
– Impaired physical mobility
 Head Injury
Nursing Management
Planning

– Overall goals:
• Maintain adequate cerebral perfusion
• Remain normothermic
• Be free from pain, discomfort, and
infection
• Attain maximal cognitive, motor, and
sensory function
 Head Injury
Nursing Management
Nursing implementation

Health Promotion
• Prevent car and motorcycle accidents
• Wear safety helmets
 Head Injury
Nursing Management
Nursing implementation

Acute Intervention
• Maintain cerebral perfusion and
prevent secondary cerebral ischemia
• Monitor for changes in neurologic
status
 Head Injury
Nursing Management
Nursing implementation

Ambulatory and Home Care

• Nutrition
• Bowel and bladder management
• Spasticity
• Dysphagia
• Seizure disorders
• Family participation and education
 Head Injury
Nursing Management
Evaluation

Expected Outcomes
• Maintain normal cerebral perfusion
pressure
• Achieve maximal cognitive, motor, and
sensory function
• Experience no infection, hyperthermia,
or pain