* 1,000,000+ patients a year in a&e * ~5000 die * biggest killer for 15-24’s
TRANSCRIPT
Head Injuries
*Head Injuries
*1,000,000+ patients a year in A&E
*~5000 die
*Biggest killer for 15-24’s
*Head Injury causes
*Falls
*Sports injuries
*Fights
*RTCs
*Get info:
*When?
*How fast?
*How high?
*What can go wrong?
*Skull fracture
*Concussion
*Compression
*NB may have spinal injury
*Concussion
*Shaking of the brain
*Temporary loss of function (‘stunned’)
*(Usually) no long term damage
*Symptoms…?
*Concussion: Symptoms
*Headache (mild)
*Dizziness
*Nausea
*Confusion
*Loss of memory
*Loss of conciousness
*Visual disturbances
*Compression
*Bleeding or swelling = increased pressure (BUT no where to go!)
*May occur straight after injury
*…OR days after!
*(so always ask about recent head injuries)
*Symptoms?
*Compression: 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
*C-spine!
*Spinal injury v likely (head is heavy)
*C3-5 keep the diaphragm alive
*Have a feel
*Pain or tenderness = immobilise!!
*So...what do you do?: Primary
Survey *Danger (fights etc)
*Response (AVPU)
*Airway
*C-Spine!!
*Recovery position?
*Breathing
*Circulation
*Event history – when depends on seriousness of Pt
999?
*So...what do you do?: Airway
*Airway is the most important thing
*If unconscious, needs to be opened.
*Head tilt / chin lift ?
*If C-spine is damaged, we can use the jaw thrust
*(BUT…what if they vomit?)
*What else?Assessment
*Feel the scalp – deformity / swelling / bleeding?
*Check for CSF fluid
*Take the pulse
*SAMPLE (inc. alcohol & drugs)
*Level of orientation (place, time, event, person)
*(But don’t take the piss)NB – Complicated
by alcohol
*Management
*C-spine? (Jaw thrust?)
*Position (sat up? Recov pos?)
*HCP? Hospital? 999?
*Sort wounds (inspect fist!)
*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!
*Look out for…
* drowsiness
*Worsening headache
*Confusion & memory loss
*Behaviour changes
*One-sided weakness
*Dizziness
*Visual disturbances
*Bleeding / CSF
*Breathing problems
*Vomiting
*..Well.. bad stuff. Namely:
*NOTE – do they have CAPACITY?? Do they understand what’s going on? Can they remember & repeat the information?
*Scenarios
*Head injury (with casualty)
*Conscious neck injury
*Unconscious spinal injury
*Sources
*http://www.nhs.uk/Conditions/Head-injury-minor/Pages/Treatment.aspx
*http://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/prehospitalcare/jrcalcstakeholderwebsite/guidelines/head_trauma_2006.pdf