Acute head injury

UNIVERSITY OF BAGHDADCOLLEGE OF MEDICINEDEPARTMENT OF SURGERY

NEUROSURGERY LECTURES
Prof. Dr. Ali Al-Shalchy
M.B.CH.B F.IC.S M.R.C.S F.R.C.S

HEAD INJURY

CLASSIFICATION OF HEAD INJURY (H.I.)

1- Blunt injury
A-Acceleration injury
B-Decceleration injury
C-Acceleration-Decceleration injury
D-Rotational injury
2-Penetrating injury


SIGNS OF A H.I.

CLOSED H.I.

MECHANISMS OF CLOSED H.I.

OPEN H.I.

DAMAGE CAUSED BY H.I.

1-Primary
2-Secondary
A-Infection
B-Brain oedema
C-Intracranial hemmorhage (I.C.H.)

BRAIN INFECTION (ABSCESS)

NORMAL & OEDAMATOUS BRAIN

I.C.H.

MANAGEMENT Of H.I.

Investigations
1-Skull X-ray
2-CT-Scan
3-MRI
4-Angiography, EEG

CT-SCAN MACHINE

MRI MACHINE

MANAGEMENT OF NON COMPLICATED H.I.

-Indications for admission of a
patient with H.I. :
1.loss of consciousness
2.skull fracture(s)
3.neurological deficit
4.medical diseases
5.convulsion following head injury
6.persistant headache and vomiting
7.doubtful cases


Line of management runs in three lines
1-Observation
A-Level of consciousness
B-Pupil
C-Vital signs
D-CNS signs (focal signs)

Level of consciousness

Glascow coma scale

COMMENT

• SCORE

• ASSESSMENT AREA

Best possible score is 15, worst possible is 3.
4
3
2
1


• Eye Opening (E)
• - Spontaneous
• - To speech
• - To pain
• - None

6
5
4
3
2
1

• BEST Motor Response (M)

• - Obeys commands
• - Localizes pain
• - Normal flexion (withdrawal)
• Abnormal flexion (decorticate)
• Extension (decerebrate)
• - None (flaccid)


5
4
3
2
1

• Verbal Response (V)

• - Oriented
• - Confused conversation
• - Inappropriate words
• - Incomprehensible sounds
• - None

Glasgow Coma Scale

MANAGEMENT ACCORDING TO SEVERITY

UNEQUAL SIZED PUPILS

2-Nursing care

A-Airway
B-Management of restless patient
C-Sphinctor care
D-Skin care
E-Feeding
F-Antibiotics

AIRWAY PIECES

ENDOTRACHEAL TUBE

ENDOTRACHEAL INTUBATION

INTUBATED SEVERELY H.I. PATIENT

TRACHEOSTOMY

TRACHEOSTOMY TUBE CARE

MECHANICAL VENTILATION

BED SORES (PRESSURE ULCERS)

TYPES OF NUTRITION

NG-TUBE

NG-TUBE

GASTROSTOMY TUBE

3-Indications for surgery

A-Simple stiching
B-Open H.I. (Penetrating)
C-I.C.H.

SUTURED SCALP WOUND

SURGERY FOR A DEPRESSED SKULL FRACTURE (CRANIECTOMY)

SURGERY FOR AN ACUTE SDH (CRANIOTOMY)

THANK YOU