Head Injury

 

With the high number of road traffic accidents and assaults, this is a fairly common injury. Early and proper management is critical in order to avoid death and long-term morbidity.

Investigations

Radiological information of CT scan is usually more informative than simple skull radiograph.

Management

 

1. Initiate resuscitation measures.
2. Document accurately the neurological status with Glasgow Coma Scale or other reliable scale.
3. Ensure adequate oxygenation and monitor fluid balance. Avoid over hydration.
4. Review regul;arly every 15-30 minutes while awaiting transportation if at level 4 and are not able to manage.
5. Arrange immediate referral to a specialized unit, and provide appropriate transportation and personnel top accompany the patient during transportation.

If at level 5 to 6:

1. Admit patient for hourly neurological observation iof:

• Depressed conscious level is observed anytime after injury.
• Skull fracture.
• Focal neurological signs elicited.
• Elderly patients

1. Record hourly neurological observations, to include:

• Glasgow Coma Scale
• Blood pressure, pulse, and respiratory rate
• Pupil size and reaction
• Limb movements (normal, mild weakness, severe weakness, spastic flexion, extension, no resp[onse)

1. Check for peripheral deep tendon reflexes
2. Carry out appropriate investigations.
3. Carry out surgical intervention as needed
4. Rehabilitate as appropriate: Physiotherapy, occupational therapy, and counseling.

IMPORTANT: Regular neurological assessment performed less often than hourly are of no use for interpretation.

 

1. If there are signs of an intracranial hematoma developing(declining conscious level, pupil signs, onset of confusion):

• Cross-match and arrange for burr hole surgery as an emergency.

1. Compound skull fractures:

• Through wound toileting and haemostasis as an emergency.
• Crystalline penicillin 2 mega units intravenous QDS and current antibiotic regime for 7 days

1. Depressed skull fractures

• Through more than one table, require elevation.

1. Basal skull fracture:

• Bloody CSF coming from the error nose is indicative of a basal skull fracture unless other external source of bleeding is seen.

1. Do not give narcotic analgesics to head injury patients

• Use paracetamol

1. Convulsions must be rigorously controlled.

• Diazepam 10-20mg intravenous and phenobarbitone 5mg IM daily.