*
* 1,000,000 Pt’s /yr in A&E
* 6000 severe – 40-50% die
* Biggest killer for 15-24’s
*
* Skin
* Skull
* Meninges
* Brain
* Brain sits in CSF fluid (acts as a shock
absorber)
*
* Falls (NB axial loading)
* Sports injuries
* Fights
* RTCs
* Get lots of info about M.O.I:
* When?
* How fast?
* How high?
* Where hit?
* How many impacts?
*
* Skull fracture
* Contusion & laceration
* Concussion
* Extradural haemotoma
* Subdural haemotoma (slow killer –
after 3 days – mortality ~50%)
* ‘Compression’ (rise in ICP)
* Primary & secondary damage
*
* Shaking of the brain
* Temporary disturbance of function
(‘stunned’)
* Usually no long term damage
* Symptoms?
*
* Headache (mild, generalised)
* Dizziness
* Nausea
* Confusion
* Loss of memory
* L.O.C
* Visual disturbances
* Concussion may be related to basilar
skull fracture.
*
* Increased ICP (bleeding or swelling)
* May occur straight after injury
* …OR days after!
* (so always ask about recent head
injuries)
* Symptoms?
*
* Deteriorating level of response (AVPU)
* Intense headache
* Nausea / vomiting
* Noisy breathing becoming shallow
* Slow, strong pulse
* One-sided weakness / paralysis
* Drowsiness
* Change in personality
* Severe amnesia
* Posturing
* Unequal pupils (NB late sign!)
* Seizures
* Lucid intervals
*
* Increased BP
* Decreased
Pulse rate
* Irregular
breathing rate
*
* Requires significant trauma
* Bruising usually develops a long
time after the event
*
*
* Danger (fights etc)
* Scene size-up (M.O.I)
* Response (AVPU)
* Airway (teeth, blood, L.O.C)
* C-Spine!!
999?
* Vomiting
* Breathing (rate, regularity, depth)
* Circulation (pulse, bleeding, skin colour)
* Disability / dysfunction
* Event history – when depends on seriousness of Pt
*
* Feel the scalp – deformity / swelling / bleeding?
* Check for CSF fluid (inside!)
* Check pupils (NB – alcohol/drugs)
* Level of response – A? V? P? U?
* Eyes
* Speech
* Motor response (squeeze fingers both sides)
* GCS score (IF you know it well!)
* Level of orientation (place, time, event, person)
* (But don’t take the piss)
*
* Lots of Obs!
* Pulse (rate / regularity / strength)
* Breathing (rate / regularity / depth)
* If available, ETA / HCP to get BP (or if serious)
* Outward signs (e.g. helmet damage)
* SAMPLE (inc. alcohol & drugs)
* Investigate symptoms & changes
* Pins and needles, numbness etc.
* If memory loss, what extent?
* If L.O.C, how long for? More than once?
NB – Complicated by
alcohol
* Changes in level of orientation (place, time, event, person)
* Investigate behaviour
*
* C-spine? (Jaw thrust?)
* Position (sat up? Recov pos?)
* Oxygen
* HCP? Hospital? 999?
* Sort wounds (inspect fist!)
* CSF fluid?
* Reassure (if hyperventilating, control this)
* Paracetamol?
* Head injury advice (next slide)
* Advise not to drink / get high
* Advise not to ‘get back on the pitch’
* Advise they’re watched by a friend (why?)
* And more OBS!
*
* ..Well.. bad stuff. Namely:
* NOTE – do they have
CAPACITY?? Do they
understand what’s going on?
Can they remember & repeat
the information?
*  drowsiness
* Worsening headache
* Confusion & memory loss
* Behaviour changes
* One-sided weakness
* Dizziness
* Visual disturbances
* Bleeding / CSF
* Breathing problems
* Vomiting
* http://www.nhs.uk/Conditions/Head-injuryminor/Pages/Treatment.aspx
* http://www2.warwick.ac.uk/fac/med/researc
h/hsri/emergencycare/prehospitalcare/jrcalcst
akeholderwebsite/guidelines/head_trauma_20
06.pdf
*