Download Free Medical Head Injury-Assessment and Management PowerPoint Presentation

Head Injury-Assessment and Management PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Neurology, which is titled "Head Injury - Assessment & Management", to know about Head Injury Assessment and Management.

Tags : Neurology, Head Injury, Assessment, Management

Published on : Aug 23, 2021 | Views : 3023 | Downloads : 15

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Head Injury Assessment & Management Olivia Wilson Belfast Health and Social Care Trust
Slide 2-

Session Overview Definition & Importance Review of head injury types Initial assessment / risk stratification Management Safety netting Red flags Personal story
Slide 3-

Definition Head injury is defined as any trauma to the head other than superficial injuries to the face (NICE 2017) Traumatic brain injury (TBI) is a non specific term describing blunt, penetration or blast injuries to the brain. TBI can be classified as mild, moderate or severe, typically based on the GCS
Slide 4-

Why important? 1.4 million attendances in EDs England & Wales with head injuries 200,000 admitted to hospitals pa Of these 1 in 5 have skull fracture or evidence brain damage 95% people sustained head injury normal / minimally impaired conscious level (GCS >12) Lower GCS increased morbidity / mortality Although most recover without specialist intervention others experience long-term disability Head Injury: Assessment & Early Management, NICE, January 2014
Slide 5-

Why Care? Head injury commonest cause of death / disability in people aged 1 – 40 years in UK High potential for poor outcome (especially if not recognised) Deaths occur at three points in time after injury: Immediately after the injury Within 2 hours after injury 3 weeks after injury
Slide 6-

Basic Anatomy
Slide 7-

Munro – Kellie Hypothesis “ The skull is a rigid compartment with non-compressible components.” - Brain (80%) Blood (10%) CSF (10%)
Slide 8-

Recap of the definition Head injury is defined as any trauma to the head other than superficial injuries to the face (NICE 2017) Traumatic brain injury (TBI) is a non specific term describing blunt, penetration or blast injuries to the brain. TBI can be classified as mild, moderate or severe, typically based on the GCS
Slide 9-

Head Injury
Slide 10-

Head Injury Classification Glasgow Coma Scale (GCS) Blunt (closed) or penetrating (open) Direct or indirect Injury type eg concussion, extradural haematoma
Slide 11-

Classification according to GCS Mild: GCS 13 - 15 Moderate: GCS 9 - 12 Severe: GCS 3 - 8
Slide 12-

Head Injury Assessment History Examination Investigations
Slide 13-

ppt slide no 13 content not found
Slide 14-

Head Injury - History Patient details – age / details Mechanism & timing Vomiting Seizure Severe / persisting headache Pre-traumatic amnesia Past medical history Medications (especially anticoagulants) Social history
Slide 15-

Head Injury - Examination GCS Pupils General behaviour Suspicion of skull fracture (depressed / basal) Neurological examination Neck examination Other injuries as indicated
Slide 16-

Glasgow Coma Scale
Slide 17-

Glasgow Coma Scale
Slide 18-

Wound Exploration Need managed correctly – ensure cleaned adequately Boggy Swelling = Higher risk of skull fracture Consider depressed skull fracture / compound injury in all open wounds May bleed +++
Slide 19-

Head Injury - Investigation Observations Record GCS - commence head injury chart Blood sugar Wound exploration Referral for ED assessment if concerns
Slide 20-

NICE CT Indications (UK) These are indications for head CT scan in UK EDs Patients who do not meet CT criteria may still need assessed and observed in hospital – be vigilant (eg severe nausea, headache, “just not right”, etc ……)
Slide 21-

Safety Net Clear written discharge advice Adult supervision Social circumstances Concussion advice What to do if concerns
Slide 22-

Head Injury Spectrum
Slide 23-

Head Injury Types Contusion Subdural hematoma Extradural hematoma Traumatic subarachnoid haemorrhage Skull fracture Concussion Scalp laceration
Slide 24-

Cerebral Contusion Bruising to the brain surface Usually caused by trauma of brain being thrown around inside the skull Often accompanied by cerebral oedema Contusions size and oedema can increase post injury Peak risk for swelling is days 3-5 post injury Increase risk of seizure activity
Slide 25-

Cerebral Contusion
Slide 26-

Subdural Haematoma Blood gathers between the inner layer of the dura mater and the arachnoid mater. Usually resulting from tears in bridging veins which cross the subdural space Venous bleed Subdural haemorrhage may cause an increase in intracranial pressure (ICP) which can cause compression of and damage to delicate brain tissue
Slide 27-

Subdural Haematoma Tear in a “Bridging Vein” Caution: Alcohol dependant patients Elderly patients Anti-coagulant usage
Slide 28-

Subdural Haematoma
Slide 29-

Extradural Haematoma Extradural hematoma is when bleeding occurs between the tough outer membrane covering the brain and the skull Arterial bleed
Slide 30-

Extradural Haematoma More common in younger patients Usually results from an arterial bleed Patients often have a “LUCID PERIOD” with relatively few symptoms followed by a rapid deterioration Carry good prognosis if diagnosed in time
Slide 31-

Concussion A concussion is a mild traumatic brain injury caused by a blunt jolt or blow to the head The sudden movement causes the brain to bounce around or twist inside the skull This leads to stretching and damaging of brain cells and causes chemical changes in the brain
Slide 32-

Concussion
Slide 33-

Concussion Concussion is regarded as a traumatic brain injury Can result from a direct or indirect blow to the head LOC is not required Children are more vulnerable Symptoms can evolve over minutes or hours after the event Helmets / scrum caps do not protect against concussion Not just sport
Slide 34-

Chemical changes from Concussion Concussive symptoms result from neuro hormonal imbalance: Limited evidence in regards to structural injury
Slide 35-

ppt slide no 35 content not found
Slide 36-

Concussion Management
Slide 37-

Scat5 Test
Slide 38-

Return to Sport
Slide 39-

Pitfalls Alcohol and drugs Poor historian Anticoagulants Safe discharge
Slide 40-

Personal Story !
Slide 41-

Happy Ending !
Slide 42-

Final Note Perform thorough work-up Know the red flags Develop head injury proforma Wound management Safe discharge policy Concussion awareness
Slide 43-

ppt slide no 43 content not found
Slide 44-

Head Injury Nurses Colin Williamson, Royal Victoria Hospital 02890 240503 Ciara O’Rourke, Beaumont Hospital 018092913
Slide 45-

References NICE Clinical Guidelines 56 – Head Injury: Triage, assessment, investigation and early management of head injury in infants, children and adults http://guidance.nice.org.uk/CG56/Guidance/pdf/English SIGN 46 – Early Management of Patients with Head Injury. www.sign.ac.uk/pdf/sign110.pdf Hickey, J.V (2003) The Clinical Practice of Neurological and Neurosurgical Nursing. Sport Concussion Assessment Tool 2 SCAT2: International Rugby Board Concussion Guidelines (2011) www.irbplayerwelfare.com/pfds/IRB_Concussion_Guidelines_EN.pdf Acquired Brain Injury Care Pathway: Neurorehabilitation (2011) www.hscboard.hscni.net/RABIIG/Acquired%20Brain%20Injury%20Pathways/Acquired%20Brain%20Injury%20Inpatient%20Care%20Pathway%20Neurorehabilitation%20-%20PDF%201MB.pdf
Slide 46-

Olivia Wilson Belfast Health and Social Care Trust