Head Injuries

*Head Injuries

*1,000,000+ patients a year in A&E

*~5000 die

*Biggest killer for 15-24’s

*Head Injury causes

*Falls

*Sports injuries

*Fights

*RTCs

*Get info:

*When?

*How fast?

*How high?

*What can go wrong?

*Skull fracture

*Concussion

*Compression

*NB may have spinal injury

*Concussion

*Shaking of the brain

*Temporary loss of function (‘stunned’)

*(Usually) no long term damage

*Symptoms…?

*Concussion: Symptoms

*Headache (mild)

*Dizziness

*Nausea

*Confusion

*Loss of memory

*Loss of conciousness

*Visual disturbances

*Compression

*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: Symptoms

*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

*C-spine!

*Spinal injury v likely (head is heavy)

*C3-5 keep the diaphragm alive

*Have a feel

*Pain or tenderness = immobilise!!

*So...what do you do?: Primary

Survey *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?: Airway

*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?)

*What else?Assessment

*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)NB – Complicated

by alcohol

*Management

*C-spine? (Jaw thrust?)

*Position (sat up? Recov pos?)

*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?)

*And more OBS!

*Look out for…

* drowsiness

*Worsening headache

*Confusion & memory loss

*Behaviour changes

*One-sided weakness

*Dizziness

*Visual disturbances

*Bleeding / CSF

*Breathing problems

*Vomiting

*..Well.. bad stuff. Namely:

*NOTE – do they have CAPACITY?? Do they understand what’s going on? Can they remember & repeat the information?

*Scenarios

*Head injury (with casualty)

*Conscious neck injury

*Unconscious spinal injury

*Sources

*http://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