HPR 010 Lecture Notes - Lecture 15: Traumatic Brain Injury, First Aid, Spinal Cord Injury
12 Jun 2018
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FACPR – Chapter 12
Head Injuries
- Any head injury is potentially serious
o Scalp wounds
o Skull fractures
o Brain injuries
- Spinal injuries can also present in people with a head injury
Scalp wounds – bleed profusely because the scalp has many blood vessels. A bleeding scalp wound does
not affect blood supply to the brain because the brain obtains its blood supply from arteries in the neck,
not the scalp.
- What to Do
o Control bleeding by pressing on wound
o Replace any skin flap to original position and apply pressure
o If skull fracture is suspected:
▪ Press on edges of wound to help control bleeding. DO NOT apply excessive
pressure: doing so many push bone pieces into the brain
o Apply a dry, sterile, or clean dressing
o Keep head and shoulders slightly elevated if no spinal injury is suspected.
o If bleeding continues, add dressings over the first dressing.
o Call 9-1-1 if wound is extensive, significant facial damage, or signs of concussion.
Skull Fracture: a break or crack in the cranium. Some may be open (w/ laceration) or closed (w/o scalp
laceration).
- What to Look For
o Pain, Skull deformity, Bleeding from ears/nose, Leakage of CSF (cerebrospinal fluid),
Discoloration around eyes or behind ears, Unequal pupils, Heavy scalp bleeding,
Penetrating object
- What to Do
o Apply sterile or clean dressing over wound and hold in place with
gentle pressure.
o Control bleeding.
o Call 9-1-1.
- What NOT to Do
o DO NOT
▪ Stop blood or CSF from coming out of ears of nose – that could increase pressure
within the skull
▪ Remove an impaled object
▪ Clean an open skull fracture
▪ Press on fractured area
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find more resources at oneclass.com
Traumatic Brain Injuries
- Injury to the brain causes most short- and long-term problems.
- Mishandling a person could result in permanent damage or death.
- The brain will swell when it is injured.
o Swelling can interfere with brain functioning.
- Brain injuries can be caused by:
o A penetrating foreign object
o Bony fragments from a skull fracture
o The brain striking the inside of the skull
- Deceleration ijury: perso’s head hits a statioary ojet.
- Acceleration injury: person has been hit by a moving object.
- Concussions (MTBI – mild traumatic brain injury)
o Occur when a blow to the head alters the function of the brain
o Recovery can last from several minutes to months, or longer.
o Most people make a full recovery.
▪ Post-concussion syndrome.
- Other Traumatic Brain Injuries
o Contusion: direct blow to the head that can cause to the brain
o Coup-contrecoup: blow to the head that causes a contusion at site of impact and hits
brain to opposite side of head. The second hit causes a second contusion.
o Diffuse axonal: shaking or strong rotation of the head that causes a tearing injury
o Penetration: a bullet, knife, or other sharp object enters the brain. The wound is then
contaminated by hair, skin, bone, and pieces of the penetrating object.
- What to Look For
o Behaviour or personality changes
o Dazed look
o Changes to balance, coordination, and reaction time
o Delayed or slowed responses
o Disorientation
o Loss of responsiveness
o Slurred speech
o Vomiting
o Headache
o Blurry vision
o Nausea, dizziness
o Sensitivity to noise or light
- What to Do
o If unresponsive, check for breathing
o If a neck injury is suspected, or if person is unresponsive:
▪ Do not move head, neck, or spine.
▪ Call 9-1-1.
o If the person is wearing helmet, do not remove unless:
▪ You suspect an obstructed airway.
▪ You cannot stabilize spine.
▪ You must remove it to provide life-saving care of an airway.
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find more resources at oneclass.com
o Seek immediate medical care for:
▪ Drowsiness
▪ One pupil larger than the other
▪ Seizure
▪ Inability to recognize people or places
▪ Confusion
▪ Restlessness
▪ Unusual behavior
▪ Unresponsiveness
▪ Headache that gets worse and/or does not go away
▪ Repeated vomiting
▪ Slurred speech
o Following injury, the person should:
▪ Get plenty of sleep and rest.
▪ Avoid visual and sensory stimuli.
▪ Ease into normal activities slowly.
▪ Avoid strenuous physical activities.
▪ Avoid another blow to head or body.
▪ Do not use aspirin or anti-inflammatory medications other than acetaminophen.
- Further Care of Brain Injuries
o Required if:
▪ Headache lasts more than 1 or 2 days.
▪ Nausea lasts more than 2 hours
▪ Vomiting occurs hours after initial episodes of vomiting have stopped
▪ Confusion or disorientation after waking
▪ Vision changes
▪ Mobility or speech impairment
▪ Seizures or convulsions
Eye Injuries
- The eyes are easily damaged by trauma.
- Examination by an ophthalmologist or other physician should occur as soon as possible after
injury.
- What to Look For
o Black eye
o Person reports being hit by fist, ball, or blunt ball
o Broken bone around eyeball indicated by
▪ Double vision
▪ Inability to look upward
- What to Do
o Apply ice or cold pack around eye for 15 minutes
▪ Do not place on eye
o Have person keep eyes closed
o Seek medical care
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Any head injury is potentially serious: scalp wounds, skull fractures, brain injuries. Spinal injuries can also present in people with a head injury. Scalp wounds bleed profusely because the scalp has many blood vessels. A bleeding scalp wound does not affect blood supply to the brain because the brain obtains its blood supply from arteries in the neck, not the scalp. What to do: control bleeding by pressing on wound, replace any skin flap to original position and apply pressure. If skull fracture is suspected: press on edges of wound to help control bleeding. Do not apply excessive pressure: doing so many push bone pieces into the brain: apply a dry, sterile, or clean dressing, keep head and shoulders slightly elevated if no spinal injury is suspected. If bleeding continues, add dressings over the first dressing: call 9-1-1 if wound is extensive, significant facial damage, or signs of concussion. Skull fracture: a break or crack in the cranium.
