Head Injury

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Complications

Can vary significanlty on severity depenant on cause and nature of injury.

Concussion-disturbance of brain function, rapid onset following injury, usually self limiting.

Post-concussion syndrome- may include multiple physical symptoms ie headaches, dizziness, nausea, balance, coordination, altered senses and cognitive changes such as behaviour.

Intracranial haemorrhage - increased risk if on anticoagulants.

Open or depressed skull fracture; basal skull fracture.

Seizures.

Problems with gait, mobility, muscle weakness.

Communication and swallowing difficulties.

Hypopituitarism with non specific symptoms.

Death.

Anxiety, depression; PTSD.

Assessment

Ask how and when injury occured.

The mechanism of injury - fall/height/speed and nature.

Current symptoms since onset- loss of conscousness/amnesia/vomiting/headhache/neck pain.

Ask about recent alchol or drug intake or any medication taken.

Ask about pre-injury level of consciousness and fucntion.

Investigation

Assess level of conscousness using Glasgow Coma Scale.

Obtain vital signs. Assess for signs of hypoxia or shock (tachycardia/hypotension/reduced CRT).

Assess for signs of visible trauma/injury.

CNS examination.

Observe for signs of basal skull fracture-clear fluid draining from ears or nose/bleeding from ears or nose/bruising behind ears/periorbital haematomas.

Assess for any neck tenderness - ?spinal injury. Assess range of neck movements.

In CHIDLREN-suspect non accidental injury should the child present with injuires no inline with explanation of cause/distorted story of cause. Any bruising to non bony part of the face or on both side of the face.

Management

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Arrange follow up reassessment if symptoms are ongoing after minor head injury.

Refer immediately, with accompanied competent adult in case of worsening or persistent clinical features including nasuea and vomiting/headaches. ?Complication.

Offer support and self care advice, advise symptoms normally resolve within 3 months and not usually serious.

Manage pain, provide effective analgesia if indicated.

Assess effect on ADLs and offer support.

Ask about management of symptoms such as anxiety/nightmares/flashbacks, particularly if persistant.

Assess any issues with alcohol and drug misuse, offer support as indicated.

Refer for specialist assessment and management if possible signs of complications following a head injury - Neurology.