Head Injury
What You should know

Guidelines for Head Injury Patients

Head injuries are a major cause of death and disability not only in westernized countires but also in the third world. Children and young adults are most often affected and that means many years of life lost or many years of'disability. Alcohol is an important factor in traffic and assault injuries. Over 90% of patients coming to hospital after recent head injusty are walking and talking and they recover uneventfully but these patients need observation for atleast 24-48 hrs. All patients with any degree of mental confusion, severe headache, repeated vomitting or fracture skull must be kept under close observation.

How To Manage A Patient At Road Side

1 . Every unconscius patient runs the risk of swallowing his or her tongue or inhaling his vomit or saliva. Blood may collect in the mouth and throat from fractures of the facial bones. Correct positioning of the patient is the simplest way to keep the airway clear. Put the patient in prone or semiprone position the jaw and tongue fall forwards and any potential aspirate dribbles out rather than down the trachea.

2. Bleeding from any site should be stopped with bandage or handkerchief.

Transportation Of The Patient

1 . If pulse is not palpable, then patient should be transported to the nearest medical centre to prevent death. But if patient looks stable, than he or she should be shifted to a medical college or centre where definite neurological care is available.

2. During transport the neck and back of the patient should be immoblised.

Hospital Management.

-Rapid Assessment using a brief neurological examination.
-Clearthe upper airway of vomitus, blood orforeign bodies.
-Immediate oxygenation of inspired air.
-If required, endotracheal intubation or tracheostomy is done. Ventilator may be required in very sick patients.
-Blood pressure is controlled.
-Any abdominal or chest injury should be looked for.
-Injuries to cervical spine to be excluded.
-External evaluation of head may reveal signs of a basal skull fracture such as mastoid eccymosis, hemotympanum (Blood in ear), black eyes and otorrhea or rhinorrhea (CSF leakage from ear or nose.

CT Scan is a very important investigation. It can detect any intracranial haematoma, contusion, oedema or infaction.

Conservative Treatment

Patients with following injuries are treated conservatively

i) Mild concussion injuries.

ii) Small contusions in brain on CT.

iii) Linear fracture of the skull.

These patients are managed with antioedema, anticonvulsant and diuretics.

Role of Surgery

Surgery is indicated in following injuries.

1) Large haematoma inside brain.

2) Large contusions.

3) Major Fractures.

4) Depressed Fractures.

Results of surgery are better in patients who are treated within 4-6 hrs. Here lies the importance of a early referral of a head injury patient to a neuro surgical centre.

Preventive Measures

i) Roads should be better designed.

ii) Helmets should be used while driving scooter, Motor Cycles.

iii) Seat belts should be used during car driving.

iv) Alcohol/Sedation/Addictions to be avaoided.

v) Children should not be allowed to drive.

vi) Traffic lines for separate vehicles with proper lane systems.

vii) Strict Monitoring by traffic police & proper check on defaulters.

viii) Traffic lights at places with heavy rush.