TRAUMATIC BRAIN INJURY
Mechanism of Injury
Penetrating(shank) vs. Blunt (no actual penetration)
Deceleration….brain crashes against skull
Acceleration…brain hit
Coup and Countrecoup…brain hits front of skull and then bounces back and the dmg is
actually on the back of the brain…even though they were hit in the front.
Primary….occurs at moment of impact…the actual injury itself
Secondary….response to initial trauma that can exacerbate primary injury…EX…loss
of brain tissue not orginially dmg.
We are gonna talk about the different kinds of head injuries first….
Skull Fractures
*Scalp Laceration
*Fracture
Depressed-bone fragment depresses thickness of skull….wh9ich compresses brain
tissue…often associated w/ laceration
S/S: dysphasia, visual changes, motor sensory and neuro deficits
TX: surgery to lift!!
Complication….infection and seizures!!!!
Linear Skull Fracture
-no displacement of bone!!
Complication: hematoma due to bld vessel injury
TX: don’t usually need tx…just monitor
, Basilar Skull Fracture
S/S: CSF leak…confirmed by halo sign!!
Battle’s sign…ecchymosis at mastoid process.
Racoon Eyes..periorbital ecchymosis
TX: surgical elevation if depressed…remove bone fragments
Prophylactic antibiotics
*HIGH RISK FOR MENINGITIS IF CSF LEAK!!!!!!!!!
Missile Injuries
-Causes focal dmg….Shank=low velocity….Bullet=high velocity
DX: really?? Do I really need to type how you are going to Dx this?? NO…
Tx: evacuate clots….control bleeding….debride areas to prevent infection….control ICP!!
Concussion
-Doesn’t usually cause structural dmg
-LOC DOES CHANGE!!!
-Hx of LOC from sec. to hr…amnesia…dizziness
-Dx: skull films…CT of brain
-LOC change less than 5 min…usually DC w/ head injury instructions….LOC change
greater than 5 min…they will be admitted.
-POST CONCUSSIVE SYNDROME…CAN AFECT ADL
-occur 2 wks to 2 mos after injury
-persistent H/A…lethargy…personality changes…shortened attention span…dec.
short term memory…changes in intellectual
ability.
Mechanism of Injury
Penetrating(shank) vs. Blunt (no actual penetration)
Deceleration….brain crashes against skull
Acceleration…brain hit
Coup and Countrecoup…brain hits front of skull and then bounces back and the dmg is
actually on the back of the brain…even though they were hit in the front.
Primary….occurs at moment of impact…the actual injury itself
Secondary….response to initial trauma that can exacerbate primary injury…EX…loss
of brain tissue not orginially dmg.
We are gonna talk about the different kinds of head injuries first….
Skull Fractures
*Scalp Laceration
*Fracture
Depressed-bone fragment depresses thickness of skull….wh9ich compresses brain
tissue…often associated w/ laceration
S/S: dysphasia, visual changes, motor sensory and neuro deficits
TX: surgery to lift!!
Complication….infection and seizures!!!!
Linear Skull Fracture
-no displacement of bone!!
Complication: hematoma due to bld vessel injury
TX: don’t usually need tx…just monitor
, Basilar Skull Fracture
S/S: CSF leak…confirmed by halo sign!!
Battle’s sign…ecchymosis at mastoid process.
Racoon Eyes..periorbital ecchymosis
TX: surgical elevation if depressed…remove bone fragments
Prophylactic antibiotics
*HIGH RISK FOR MENINGITIS IF CSF LEAK!!!!!!!!!
Missile Injuries
-Causes focal dmg….Shank=low velocity….Bullet=high velocity
DX: really?? Do I really need to type how you are going to Dx this?? NO…
Tx: evacuate clots….control bleeding….debride areas to prevent infection….control ICP!!
Concussion
-Doesn’t usually cause structural dmg
-LOC DOES CHANGE!!!
-Hx of LOC from sec. to hr…amnesia…dizziness
-Dx: skull films…CT of brain
-LOC change less than 5 min…usually DC w/ head injury instructions….LOC change
greater than 5 min…they will be admitted.
-POST CONCUSSIVE SYNDROME…CAN AFECT ADL
-occur 2 wks to 2 mos after injury
-persistent H/A…lethargy…personality changes…shortened attention span…dec.
short term memory…changes in intellectual
ability.
