What Is a Severe Head Injury?

Scalp lacerations are mostly caused by sharp or blunt objects. The size and depth of the slits are different, and the wound margins are neat or irregular, sometimes accompanied by skin contusions or defects. Due to the rich scalp blood vessels, the blood vessels are not easy to close after rupture. Even small wounds are severe, and even shock occurs.

Head injury

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scalp

Children's naughtiness makes them vulnerable to head trauma. The main danger of head trauma is intracranial hemorrhage, which causes brain damage, but only a few head injuries can be fatal.

If the head trauma is minor, there are no symptoms other than a slight headache or swelling in the peritoneum. However, if the head is severely hit, a concussion may occur.

Common symptoms after a concussion include: confusion, vomiting, inability to remember what happened before, dizziness, and blurred vision.

Severe head trauma can result in loss of consciousness for more than a few minutes and even coma. A yellow fluid or blood from the nose or ears of the child may indicate a skull fracture. Call an ambulance immediately or take him to the emergency department of the nearest hospital. The doctor will check the condition of the child. Cuts to the scalp require sutures to prevent continued bleeding. If the child has a skull fracture, a skull X-ray may be scheduled, or a brain CT may be performed to determine if surgery is needed. If the child has a minor head injury, he should rest at home for 2-3 days.

During the first 24 hours, you should closely observe the condition of the child. If you have symptoms such as drowsiness, vomiting, irritability, confusion, blurred or incoherent speech, nose or ears exuding fluid or blood, you should take him back to the hospital immediately treatment.

Minor head trauma does not cause long-term regression. Severe head trauma can cause permanent brain damage, which can cause physical or psychological disturbances.

Caused by trauma. Scalp avulsion injuries are often caused by strong scalp involvement. For example, if the scalp is involved in a rotating machine, part or the whole of the scalp is peeled off from the sub-fascia or periosteum, causing severe injuries, bleeding and easy to occur. shock.

(A) classification of brain injury

The purpose of grading is to facilitate the formulation of routine diagnosis and evaluation of efficacy and prognosis and identification of injuries. Graded according to the severity of the injury Mild (grade I) mainly refers to simple concussions with or without skull fracture and coma with mild symptoms such as mild headache and dizziness within minutes. Neurological and cerebrospinal fluid examinations have no significant changes; Medium (grade ) mainly refers to Mild cerebral contusion or small intracranial hematoma with or without cranial fracture and subarachnoid hemorrhage. No cerebral pressure sign. Coma. Minor positive neurological signs within 5 hours. Mild vital sign changes. Severe (Grade III) Mainly refers to extensive skull fractures, extensive brain contusion, brain damage, or intracranial hematoma coma over hours. The consciousness gradually worsens or re-coma has obvious positive neurological signs and obvious changes in vital signs. According to the Glasgow coma score method, those with more than one hour of unconsciousness are classified as mild-classified as moderate-classified as severe. No matter which classification method is used, it must be connected with clinical observation of pathological changes of brain injury and CT examination. Dynamically and comprehensively reflect the injury, such as simple concussion in the early stage of injury. The injured person may be comatose again due to intracranial hematoma during observation. The small intracranial hematoma found by CT examination does not shift during the injury. There was no change in the condition during the initial period of coma or no coma. It is medium-sized; early CT scans within hours of the wounded showed no intracranial hematoma. Later, when he was re-examined, hematoma was observed and the midline structure was obviously shifted. At this time, although the consciousness was still clear, it was severe.

(II) Emergency treatment requirements

Mild (Grade I) (1) Stay in the emergency room for hours; (2) Observe the pupil vital signs and nervous system signs of consciousness; (3) Skull X-ray radiographs for skull CT examination if necessary; (4) Symptomatic treatment; ( 5) Talk to your family about the possibility of delayed intracranial hematoma.

Medium-sized (Class II) (1) Those who have a clear awareness stay in the emergency room or stay in the hospital for observation-for hours, those with a conscious disorder must be hospitalized; (2) Observe the changes in vital signs and neurological signs of conscious pupils; (3) X-ray skull CT Examination; (4) symptomatic treatment; (5) head CT review when there is a change in condition to prepare for surgery at any time.

Severe (Grade III) (1) Must be hospitalized or in an intensive care unit; (2) Observe changes in pupil vital signs and nervous system signs of consciousness; (3) Use head CT to monitor intracranial pressure monitoring or brain evoked potential monitoring; (4) ) Actively treat patients with hypercranial epilepsy and other manifestations of increased intracranial pressure to give dehydration and other treatments to maintain good peripheral circulation and cerebral perfusion pressure; (5) focus on coma care and treatment to ensure that the airway is unblocked first; (6) have surgical indications Patients should undergo surgery as soon as possible; when a cerebral hernia has been given,% mannitol ml and furosemide mg will be injected immediately.

( C) Nursing and treatment of coma patients

Long-term coma is usually caused by serious primary brain injury or secondary brain injury that is not handled in time. If you can prevent various complications and keep the internal and external environment stable, the body will no longer suffer from cerebral ischemia and hypoxia. Or adverse effects such as water and electrolyte disorders, a considerable number of patients are expected to strive for a better prognosis

1. Respiratory tract: To ensure that the respiratory tract is unobstructed and to prevent insufficient gas exchange is the first priority. During on-site first aid and transportation, care must be taken to remove respiratory secretions and vomiting. Turn the head to the side to avoid aspiration. Deep coma must lift the lower jaw or put the pharyngeal ventilation tube Enter the pharyngeal cavity to prevent the back of the tongue from obstructing breathing. It is estimated that people who are not awake in a short period of time should be tracheal intubated or tracheotomy to reduce breathing as soon as possible Physiologically remove respiratory secretions in time to maintain the humidity and temperature of the inhaled air. Attention should be paid to disinfection, isolation and aseptic operation, and regular bacterial culture and drug sensitivity tests of respiratory secretions. Is the key to prevent and treat respiratory infections.

2. Head position and body position: The head is raised. It is good for cerebral venous reflux. It is helpful for the treatment of cerebral edema. In order to prevent bedsores, it is necessary to constantly change the area where the body comes in contact with the mattress to prevent the skin of the bone protruding part Constantly pressured ischemia.

3. Nutrition: Nutritional disorders will reduce the body's immunity and repair functions, making it easy to occur or exacerbate complications. Early use of parenteral nutrition such as intravenous input% fat emulsion% amino acid% glucose and insulin and electrolyte vitamins to maintain the need for intestinal peristalsis After recovery, enteral nutrition can be used to gradually replace the intravenous route to provide daily nutrition through the nasogastric tube or nasointestinal tube. For more than one month of enteral nutrition, gastrostomy can be considered to avoid nasopharyngeal esophageal inflammation and erosion. In addition to intestinal nutrition can be mixed with milk and mayonnaise and other mixed meals. Kl / ral (kcal / m) wells can also be used in addition to a variety of vitamins and trace elements. Commercial preparations are usually formulated with casein vegetable oil maltodextrin as a matrix containing various vitamins and trace elements. The total calories and protein of kJ / ml in adults can provide about kj (kcal) and g of nitrogen every day. There can be hyperthermia infection, increased muscle tone or epilepsy, and it is necessary to increase the timing to measure weight and muscle fullness as appropriate. Monitoring nitrogen balance plasma autoprotein blood glucose electrolytes and other biochemical indicators. And immunological tests such as lymphocyte counting to adjust calories and the supply of various nutrients in a timely manner.

4. Urinary retention: Long-term catheterization is the main cause of urinary tract infections. As far as possible, non-urinary catheterization is used. For example, when the bladder is not excessively swollen, a hot compress massage is used to promote urination; sterilization must be strictly performed during catheterization. Choosing a high-quality silicone-sealed urinary catheter and removing the catheter as soon as possible should not exceed-days; regular urine routine urine bacterial culture and drug sensitivity tests require long-term urinary catheterization may consider performing suprapubic cystostomy to reduce the urinary system infection.

5. Promote awakening: The key lies in early prevention and treatment of cerebral edema and timely release of increased intracranial pressure and the avoidance of adverse factors such as hypoxic and high fever epilepsy on brain tissue; if the condition is stable, it is still not awake. Citicoline, diethyl ether, glutamine, and chlorolipid can be used to awaken the brain fan and energy mixture or other hyperbaric oxygen chamber treatment. It can help to regain some of the wounded.

Symptomatic treatment and complications

Common causes of high fever are brain stem or hypothalamic injury and relative hypoxia caused by high fever such as respiratory urinary tract or intracranial infection, which increases brain damage. Therefore, active cooling measures must be taken. Common physical cooling methods are ice caps or head and neck axillary groin. Place ice packs or towels with ice water. If the body temperature is too high, physical cooling is not effective or causes chills. Hibernation therapy should be used. Commonly used chlorpromazine and promethazine or mg intramuscularly or intravenously. After a few minutes, physical cooling begins to maintain rectal temperature. Depending on whether there is chill or not and the patient's tolerance to the drug, the medication can be repeated every hour. Generally, the hibernation drug can reduce blood vessel tension and weaken cough reflex. Therefore, you must pay attention to master the dose to maintain blood pressure. Tracheotomy

1. Restlessness: The injured person suddenly becomes restless during the observation period. It is usually a sign of worsening consciousness, which may indicate intracranial hematoma or cerebral edema. Patients who have consciousness may be agitated due to pain, increased intracranial pressure, urinary retention or environmental discomfort. Find the cause and deal with it before considering sedation

2. Subarachnoid hemorrhage: Antipyretic analgesics can be given as symptomatic treatment for headaches, fever, and neck stiffness caused by brain lacerations. After the injury-once the injury stabilizes, it can be done daily or every other day. Lumbar puncture releases an appropriate amount of bloody cerebrospinal fluid until the cerebrospinal fluid is clear. In the early stage, when intracranial hematoma cannot be ruled out or the intracranial pressure is significantly increased, lumbar spine puncture is contraindicated to prevent the formation of cerebral hernia or exacerbate cerebral hernia.

3 Traumatic epilepsy: Epilepsy can occur in any part of the brain, but the highest incidence of damage to the frontal and parietal cortex of the cerebral cortical motor area. Early (within months after injury) seizures are often caused by skull fractures and subarachnoid spaces. Bleeding intracranial hematoma and cerebral contusion and laceration; late-onset epilepsy (more than one month after injury) are mainly caused by brain scar brain atrophy brain cyst arachnoid infection and foreign body, etc. each time caused by phenytoin sodium. Diazepam (Diazepam) ~ mg three times daily for the prevention of seizures. Slow intravenous injection. If the seizures cannot be stopped, repeat the injection until the seizures are stopped. Then add diazepam to the% glucose solution. Intravenous instillation does not exceed mg. Continuous medication should be continued after epilepsy is completely controlled for consecutive days-the dose must be gradually reduced to stop the drug. Sudden discontinuation of medication is often the cause of seizures. EEG should not be reduced when there are spikes, slow waves or paroxysmal slow waves. Or discontinued

4 Gastrointestinal bleeding: Induced ulcers caused by hypothalamic or brainstem injury. Large-scale use of corticosteroids can also induce the use of proton pump inhibitor omeprazole (Losec.) Mg in addition to blood transfusion to supplement blood volume and stop hormones. Intravenous injection every hour until bleeding stops and then use H receptor antagonist ranitidine. g or cimetidine (mesocyanine) g intravenous infusions daily for consecutive days

5. Diabetes insipidity: urine volume caused by hypothalamic damage> ml daily urine specific gravity