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Head and Brain Injuries, Incidents and Epidemiology, Field Assessment…
Head and Brain Injuries
Scalp Lacerations
are common and can range from minor to major. Due to the great vascularity of the scalp and face even small lacerations can lead to significant blood loss in a short amount of time.
Immediate management includes debridement, saline rinse, gauze, antiseptic solution and in severe cases transport for approximation and wound closure
Skull Fractures
The four categories of skull fractures are depressed fractures, linear fractures, basilar fractures, diastatic fractures
Signs and symptoms include bleeding, ecchymosis, pain, swelling, and redness or warmth.
Headache nausea blurred vision diminished pupillary reaction to light excessive drowsiness and fainting
Basilar skull fractures are associated with a higher rate of cerebral bleeding with signs including periorbital bruising, bruising in the mastoid area, or blood pooling behind the eardrum, leakage of cerebral spinal fluid through the ear
Concussion
Signs and symptoms include headache, fatigue, blurred vision, irritability, inappropriate emotions or behaviors, nausea, fainting, poor concentration and memory, and drowsiness.
In most cases transport is not required but the patient should not be left alone over the next few hours to determine if their condition is deteriorating
Indications for immediate transport include loss of consciousness greater than one minute, suspected c-spine, injury high impact or high-risk MOI for intracranial bleed, suspected skull fracture, post-traumatic seizure
Any significant & acute worsening of persistent nausea and vomiting, focal neurologic defects, deteriorating neurologic status; including slurred speech, inability or difficulty walking, worsening mental status, progressive sleepy or drowsiness.
Chronic Traumatic Encephalopathy
CTE is the physiological brain degeneration caused by a protein known as Tau, which forms clumps in the brain tissue that spread over time.
An official diagnosis of CTE is made during the autopsy
Intracerebral Contusion
A contusion differs from a hematoma in that with a contusion, blood is intermixed with brain tissue contusions can occur in combination with skull fractures or hematomas.
Contusions can be present in any area of the brain but are more common in the frontal and temporal regions
Suspected brain contusion should lead to immediate transport
Epidural Hematoma
are focal injuries often caused by a linear or direct impact force in patients who aren't wearing a helmet
Initial efforts should include stabilization of airway breathing and circulation. Followed by a thorough trauma evaluation including inspection of skull fractures
patient should be immobilized and transported
Subdural Hematoma
Are the leading cause of sports-related fatalities and are frequently reported in football.
Bleeding collects under the inner layer of the dura mater but is external to the brain and arachnoid membrane.
A subdermal hematoma can become life-threatening very quickly and acute subdermal hematoma occurs within 72 hours after injury well a chronic subdermal hematoma may take as long as three weeks to show signs
Headache
Headaches are one of the first signs of a medical emergency, particularly after a traumatic brain injury
Differentiating between a primary and secondary headache is the first step
Primary headaches, which include migraines are those that are the pathology the headache is the primary complaint, and no other medical condition could have caused the pain
Secondary headaches are those felt as the result or symptom of a separate pathology or injury, such as TBI, whiplash, or environmental changes.
Intracranial Pressure
A blow to the head that results in Intracranial pressure produces swollen brain tissue, excessive blood, or cerebral spinal fluid exerting pressure on the skull
Other causes might include infection, tumor, stroke, aneurysm, epilepsy, hypoxemia, and meningitis.
Suspected brain hemorrhage should lead to immediate transport
Incidents and Epidemiology
From 2001 to 2010, five of every 1000 people experienced TBI each year respectively. In 2010 2.5 million people were either treated in emergency departments, admitted to hospitals, or died as a result of a TBI. In the general population, the most common cause of TBI in adolescence and the elderly are falls.
In young adults, however, the most common cause is motor vehicle accidents and assaults. In the military setting, the majority of TBIs are sociated with accidents at 74% while battle-related trauma accounts for only 11%
Field Assessment Techniques
The field assessment begins with the initial clinical assessment to rapidly identify life-threatening conditions followed by a thorough secondary survey. Any patients with visible or palpable bony defects should be transported
Affecting millions of people worldwide, traumatic brain injuries are considered a major cause of death and disability.
Typically categorized along a severity spectrum as mild moderate or severe classification is based on several factors including neurological symptoms, amnesia, imaging scan results, and duration or severity of unconsciousness.
