Elevate the head.
HEAD TRAUMA TYPES OF HEAD TRAUMA
COURSE OUTLINE
ETIOLOGY OF HEAD TRAUMA SKULL FRACTURE
IMMEDIATE ASSESSMENT
INTRACRANIAL PRESSURE - Crack in the bone skull
TYPES OF HEAD TRAUMA
Assessment
SEQUELAE OF HEAD TRAUMA
Orbital ecchymosis
CAUSE
Multiple-trauma accidents (vehicular accidents)
Fall
Struck by objects intentionally or unintentionally
GLASGOW COMA SCALE
Postauricular ecchymosis
Eye Opening Score
Opens eye spontaneously when you approach 4
Opens eye in response to speech 3
Opens eye in response to painful stimuli such 2
as pressure in nail bed
Does not open eyes in response to painful 1
stimuli
Motor Response Score
Can obey simple command such as “hand me 6
this pen”
Moves an extremity to locate painful stimulus 5
applied to the head or trunk and attempts to Rhinorrhea
move the source Otorrhea
Attempt to withdraw from the source of pain 4
Flexes arms at the elbows and wrists in 3 Types of Skull Fracture
response to painful stimuli to the nail beds
Extends arms in response to painful stimuli 2 I. Depression fracture
No response to pain on any extremity 1 II. Compound fracture
Verbal Response Score III. Hairline fracture
Oriented to time, place, and person knows or 5 IV. Subdural hematoma
can recognize the names, date, and where
he/she is
Able to converse, although not oriented to 4
time, place, or person
Speaks only in words or phrases that make 3
little or no sense
Responds in incomprehensible sounds 2
No verbal respond 1
Total Score 15
SCORE
Therapeutic Management
3 to 8: severe trauma
Admission for observation
9 to 12: moderate trauma Semi-Fowler’s position
Do not occlude nostrils that may halt the drainage
13 to 15: mild/slight trauma Prophylactic antibiotics
Surgery
INTRACRANIAL PRESSURE
Signs and Symptoms SUBDURAL HEMATOMA
- Venous bleeding into the space between the dura
Pupils are slow or unable to react immediately and the arachnoid membrane.
Decrease level of consciousness and motor ability - Occur more common in infants than in older
Pulse and Respiratory rates decreases children.
Temperature and pulse pressure increases
Immediate Management
ICP monitoring.
Cranial CT or Cranial MRI.
IV hypertonic solution to increase intravascular
pressure and shift the edema fluid back into the
blood vessels.
Steroids to decrease inflammation and edema.
@NurseMD_
- May occur on the side of the skull or on the opposite
side of the brain
Note: symptoms may occur 3 days or 20 days after the
trauma
Signs and Symptoms
Increased ICP
Seizure Signs and Symptoms
Vomiting
Hyperirritability Transient loss of consciousness at the time of injury
Enlargement of the Head May vomit and may show irritability
Anemia No memory (amnesia) of the events leading up to
the injury
Treatment
Diagnostic
Subdural puncture
Surgery Skull X-Ray
Instructions
EPIDURAL HEMATOMA
Observation for 24 hours
- Bleeding into the space between the dura and the Can be observed at home by the parents (1 to 2
skull hours while the child is awake)
Parents can ask the child to name familiar objects,
places or persons ∙ Go to the nearest hospital or call
the hospital if there are any questions
CONTUSION
- occurs when there is tearing or laceration of
brain tissue
- symptoms are the same type as concussion but
more severe
Cause
Signs and Symptoms
Severe head trauma
Rupture of the middle meningeal artery Focal Seizure
Rapid brain compression Eye deviation
Loss of speech
Signs and symptoms
Momentarily unconscious
Signs of cortical compression: vomiting, loss of
consciousness, headache, seizure or hemiparesis
Unequal dilation or constriction of the pupils may be
present.
Decorticate posturing-indicates extreme pressure on
upper cortical centers.
Note:
If the pressure is allowed to continue unchecked, cortical
compression may be so great that the brainstem, respiratory
or cardiovascular function becomes impaired.
Note: Surgery may be necessary to halt bleeding. Child’s
Treatment
prognosis depends on the extent of the injury and
Surgical removal of the accumulated blood and cauterization effectiveness of the therapy.
or ligation of the torn artery.
Discharge teaching
CONCUSSION
- Temporary and immediate impairment of neurologic
function caused by a hard, jarring shock
@NurseMD_
Endotracheal intubation if with acute signs of
respiratory difficulty ∙ IVF insertion
Series of diagnostic tests
Monitoring of vital signs and neuro vital signs every
15min to 20min or as ordered by the physician
SEQUELA OF HEAD TRAUMA
COMA – unconsciousness from which a child cannot be
roused.
STUPOR – grogginess from which a child can be roused
Note: Coma and stupor may be present in children after sever
head trauma. Origin of the trauma must be obtain so that
treatment can be directed specifically toward the cause.
Assessment
Obtain a history to determine the circumstances
immediately before the time the child became
comatose.
Undress the child completely so that all body parts
can be inspected ∙ Take child’s vital signs
Observe for signs of increase ICP
If bulbar (brainstem) compression is present, a child
cannot swallow effectively or safely
Observe for papilledema; caused by long-standing
increased pressure on the brain more than 24 to 48
hours.
Observe for lack of a doll’s eye reflex that suggests
compression of the oculomotor nerve or of the
brainstem is involved
Observe for posturing, such as decerebrate
posturing, which suggests cerebral compression and
dysfunction
Diagnostics
Blood glucose
Blood electrolytes (Na, K)
Blood urea nitrogen (BUN)
Liver function test (Creatinine)
Blood gas (ABG)
Lumbar puncture (LP)
Cranial CT Scan or MRI
Therapeutic Management
Admission
Place child on the side to reduce the risk of
aspiration
Oral suctioning to remove mucus from the mouth
and pharynx
@NurseMD_
