Chapter 5 Head injuries
Chapter 5 Objectives
• Describe the anatomy of the head.
• Understand that head injuries can be
prevented.
• Understand the urgency involved with caring
for brain injuries.
• Describe the numerous types of head
injuries.
Anatomy
• Skull has 28 bones
• Main function-protection of the brain
• Suture line is area where bones come
together
• Only moveable joint in head is the mandible
• http://www.upstate.edu/cdb/grossanat/hnsklat
.shtml
The Brain
• Weighs only 3 pounds
• Requires 20% of the total blood oxygen
and 15% of the blood supply of the body
• Brain cells grow and develop until age
18
• After that, brain cells cannot be
reproduced
The brain
• Lack of oxygen first causes unconsciousness
and possibly death
• Pupils dilate
• Brain death can occur within 4-6 minutes
• http://faculty.washington.edu/chudler/color/pic
3.html
The brain
• Divided into lobes
• Named after bone
that covers it
• Each lobe
responsible for
specific body
functions
• Attaches to the
spinal cord at the
brain stem
The brain
• Cerebrospinal fluid covers the brain and
spinal cord
– Helps maintain regular pressure
– Protects brain from impacts
– Severe head injury can cause leakage of
fluid, should not stop drainage… causes
increased pressure and more brain
damage
The scalp
• Part of the skin-covers skull
• Contains large # of blood vessels, muscles,
and hair
• Skin
– Protects against infections
• Hair
– Protects skin from sun and keeps dirt and sweat
away from eyes
• Blood vessels
• Even small cut causes profuse bleeding
The scalp
• Decreases force of impact due to
additional padding
• Without a scalp it is believed that a skull
could fracture with only 40 lbs of
pressure
• With scalp, may take 425 lbs
• Do not judge head injury by amount of
bleeding
Preventing Head Injuries
• Protective measures
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Helmets
Mouth guards
Rules
Common sense
Mouth guards
• Often forgotten
• Impact to chin drives
mandible into maxilla and
causes brain stem to twist
slightly, causing loss of
consciousness
• Mouth guard provides
shock absorption
Helmets and face masks
• Proper tackling skills
important
• Recommend
showing video to
athletes on sport
safety
• Explain signs,
symptoms, and
seriousness of head
injuries to athletes
Mechanisms of Injury
• Impact
– Most common
– Temporal region most susceptible, thinnest
area of bone
– Contrecoup- brain is injured on opposite
side of site of injury/direct blow
• Rotation
– Can cause brain stem to stop functioning
normally
– Nerve receptors overload, causes
unconsciousness, unconsciousness allows
for a sorting of impulses
Skull fracture
• Significant force
required
• Cause bleeding
under skin,
sometimes
laceration
Types of skull fractures
• Depressed
– Pushes portion of
skull inside toward
brain
• Linear
– Goes across skull,
causes tears in blood
vessels on the inside
of skull
Types of skull fractures
• Compound
– Results in part of
skull sticking
through scalp,
profuse bleeding
• Penetrating
– Involves impaled
object
Fractures
• Battle Sign
– Result of skull
fracture
– Any skull fracture
requires immediate
physician referral
Concussions
• Temporary impairment of brain function caused by
impact or rotational force
• http://whyfiles.org/190sport_injury/index.html
concussion
• Symptoms
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Nausea
dizziness
headache
vomiting
difficulty speaking
tinnitus
loss of balance
Unconsciousness
Amnesia (retrograde or anterograde)
Possible battle sign
disorientation
Concussion grading
• Grade 1:
– Transient confusion;
– NO loss of consciousness;
– Concussion symptoms clear in less than 15 minutes.
• Grade 2
– Transient confusion;
– NO loss of consciousness;
– Concussion symptoms or mental status abnormalities last
longer than 15 minutes.
• Grade 3
– Any loss of consciousness, either brief (seconds) or
prolonged (minutes).
• Source: (American Academy of Neurology)
Other concussion
signs/symptoms
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Rapid eye movements/fluttering
Unequal pupils
Coma
Increased blood pressure
Decreased pulse rate
Signs of shock
Can lead to death or paralysis
Consider possibility of neck injury
Other considerations
• Consider other
possible injuries
• Monitor and see
physician
• IMPACT testing
Intercranial hematoma
• Severe bleeding within the brain caused by
blow to the head
• Usually over temporal or parietal regions
• Causes increased pressure on brain
• Death can occur
• Can be mistake for a concussion
• Only 40% survival rate if athlete goes into a
coma
• Survival depends on early exam and prompt
surgical care
• Physician drills hole in skull to drain blood,
releases pressure, and attempts to repair
blood vessel
Symptoms of intercranial
hematoma
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Headaches
Nausea
Vomiting
Loss of consciousness
Paralysis of extremities on the opposite side
of injury
• Battle sign
• Call EMS immediately
Signs of intercranial hematoma
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Rise in blood pressure
Drop in pulse rate
Pupil on same side of head injury dilated
Difficulty speaking
Difficulty using extremities on opposite side of the
hematoma
Stiffening of posture
Rapid eye movements
Lack of coordination
Unconsciousness or coma
Post-concussion syndrome
• Persistence of symptoms
– Headache
– Tinnitus
– Dizziness
– Confusion
– Should not last more than a week
– Need to see physician
Second-Impact Syndrome
• Happens when athlete returns to activity
too soon after concussion
• Second blow to head can cause loss of
brain function and coma
• Importance of IMPACT testing