Introduction
Head injury is a common emergency presentation in the ED, and it can be challenging to manage. They can range from minor injuries such as scalp lacerations to severe traumatic brain injuries. The management of head injuries in the emergency department requires a comprehensive approach to assess the severity of the injury, provide appropriate treatment and monitor the patient for any complications.
In this blog post, we will discuss best practices for managing head injuries in the ED setting and provide some tips on how to ensure optimal patient outcomes.
Head Injury Types
There are three main categories of head injury – mild traumatic brain injury (mTBI), moderate TBI (MTBI) and severe TBI (sTBI).
Mild Traumatic Brain Injuries(mTBI) typically involve a short period of unconsciousness or confusion following impact.
Moderate Traumatic Brain Injuries(MTBIs) involve more serious symptoms such as prolonged loss of consciousness or amnesia lasting over 24 hours after impact.
Severe Traumatic Brain Injuries( sTBIs) are typically life-threatening due to significant damage caused by direct brain tissue disruption from blunt force trauma or penetrating objects such as bullets/knives etc., resulting in long-term disability if not fatal outcome .
Assessment of Head Injuries
The assessment of head injuries should begin with a primary survey to identify and treat any life-threatening injuries. A detailed secondary survey should follow this to evaluate the severity of the head injury.
The Glasgow Coma Scale (GCS), a widely used tool to assess the level of consciousness in patients with head injuries, also provides a score to assess the severity and helps determine the need for oxygen therapy if necessary. A score of less than 8 on the GCS indicates severe injury, and the patient should be intubated and transferred to a neurosurgical centre as soon as possible.
Imaging studies such as a non-contrast CT scan of the head should be obtained to identify any intracranial bleeding or other traumatic injuries. The use of CT scans has been shown to improve the detection of traumatic brain injury and reduce the need for hospital admission in patients with minor head injuries.
Administering medications depending on type & severity & monitoring closely for any changes that may indicate increased intracranial pressure requiring surgical intervention like craniotomy etc. Additionally, attention must also be given towards recognizing secondary complications related with hypoxia, hypotension, and hypercapnia among others that can further worsen prognosis when left untreated.
Treatment of Head Injuries
The management of head injuries involves the prevention and treatment of any secondary brain injury. This includes maintaining adequate oxygenation, blood pressure, and intracranial pressure. Patients with severe head injuries may require intubation and mechanical ventilation to maintain airway patency and oxygenation.
Surgical intervention may be required in patients with significant intracranial bleeding or a depressed skull fracture. In patients with intracranial haemorrhage, reversal of anticoagulation therapy with medications such as vitamin K, fresh frozen plasma or prothrombin complex concentrates should be considered.
Prevention of complications
Patients with head injuries are at risk of developing secondary complications such as increased intracranial pressure, seizures, and infections. Monitoring for these complications should be performed regularly, and appropriate interventions should be initiated if necessary.
Case Study
A 45-year-old male presented with a history suggestive of a road traffic accident involving his motorcycle during which he sustained a severe closed-head injury leading him into a coma state at the time of admission. The CT scan showed evidence of a massive epidural hematoma and the patient was intubated and taken to theater for evacuation and was admitted to the ICU where he slowly improved and was later discharged to the ward and subsequently discharged home with minimal neurological challenges
Conclusion
The management of head injuries in the emergency department requires a comprehensive approach to assess the severity of the injury, provide appropriate treatment and monitor the patient for any complications. The use of imaging studies such as a non-contrast CT scan of the head has been shown to improve the detection of traumatic brain injury and reduce the need for hospital admission in patients with minor head injuries.
Preventing and treating any secondary brain injury is crucial to improving the patient's outcome. Prompt recognition of the severity of the injury and appropriate transfer to a neurosurgical centre can improve the patient's prognosis.