What Is a Traumatic Head Injury?

Trauma that occurs in the skull is a common type of injury, with fall injuries and bump injuries being the most common, followed by injuries. It often occurs in disasters, wars or traffic accidents. Occupies an important position in trauma throughout the body. Craniocerebral trauma can be divided into three categories: soft tissue (scalp) injury, skull injury (fracture), and intracranial tissue (cerebral vascular and meningeal) injury. Open craniocerebral trauma refers to trauma in which brain tissue communicates with the outside world through the wound, which can involve all parts of the skull, with varying degrees of severity. Brain damage is decisive for prognosis. Due to the special physiological function of brain tissue, the death rate of traumatic brain injury is the highest among all other parts of the body. Therefore, the rescue and treatment of craniocerebral trauma is of great significance in both wartime and peacetime.

Trauma that occurs in the skull is a common type of injury, with fall injuries and bump injuries being the most common, followed by injuries. It often occurs in disasters, wars or traffic accidents. Occupies an important position in trauma throughout the body. Craniocerebral trauma can be divided into three types: soft tissue (scalp) injury, skull injury (fracture), and intracranial tissue (cerebral vascular and meningeal) injury. These three types of injuries often occur in combination. Open craniocerebral trauma refers to trauma in which brain tissue communicates with the outside world through the wound, which can involve all parts of the skull, with varying degrees of severity. Brain damage is decisive for prognosis. Due to the special physiological function of brain tissue, the death rate of traumatic brain injury is the highest among all other parts of the body. Therefore, the rescue and treatment of craniocerebral trauma is of great significance in both wartime and peacetime.

Chinese name

Traumatic brain injury

Foreign name

craniocerebral trauma

Craniocerebral trauma I. Etiology and related diseases

1 Traumatic brain injury 1, blunt injury

Common injuries include sticks, bricks, hammers, axe, etc. The scalp contusion and laceration caused by this type of injury has an uneven wound margin, the skull is comminuted fracture with depression, the dura mater is often punctured by the fracture piece, the area of brain tissue contusion and laceration is large, and may be accompanied by intracranial hematoma and a certain degree Brain hedge wounds often have foreign body, hair, sand and other contaminated wounds, and the incidence of infection is high.

2 Traumatic brain injury 2, sharp injury

Common injuries include knives, axes, daggers, etc. The scalp injury caused by this type of injury is neat, the skull is slotted or trapped, and there are also lacerations and bleeding in the dura mater and brain tissue, and hedge brain injuries are rare. Sharp wounds are usually less contaminated, intracranial foreign bodies are rare, and the incidence of infection is low.

3 Traumatic brain injury 3, fall injury, fall injury

Caused by a fast-moving skull hitting an angular or protruding fixture. Often cause scalp lacerations, with local or extensive skull fractures and cerebral contusions, hedge-brain injuries are more common, and intracranial hemorrhage and infection are more likely.

Craniocerebral trauma related diseases: soft tissue (scalp) injury, skull injury (fracture) and intracranial tissue (cerebrovascular and meningeal).

Intracranial infection is the most common complication after craniotomy in patients with traumatic brain injury, and it is the cause of death in patients with craniocerebral surgery. If intracranial infection is not handled and treated properly, it will not only increase the medical cost of the patient, but also lead to the impairment of the patient's neurological function, which will cause a serious threat to the life of the patient.

Craniocerebral trauma II. Differential diagnosis

The main diagnostic methods of craniocerebral trauma are: plain radiograph, CT examination and lumbar puncture to see if the infection is in the skull.

1X Traumatic brain injury 1, plain radiograph

You can understand the scope of skull fractures, the depth of depressions, intracranial foreign bodies, the distribution of bone fragments, and the pneumonia. Open wounds should be used as a routine examination, including tangential photographs of the lateral and depression areas.

2CT Traumatic brain injury 2, CT examination

It can clarify the location and scope of brain injury, understand the presence of secondary intracranial hematomas, and make precise positioning of the location and distribution of foreign bodies or bone fragments. It has important diagnostic value for the later hydrocephalus, brain abscess, perforation of the brain and epilepsy.

3 Traumatic brain injury 3. Lumbar puncture

The purpose is to understand whether there is intracranial infection and to give antibiotics intrathecally if there is intracranial infection.

With the development of medical imaging and the continuous popularization of clinical applications, the accuracy of traumatic brain injury diagnosis and prognosis estimation has greatly improved. X-ray films, cerebral angiography and ventricular angiography are often used in the past, but are now replaced by CT examination. In particular, patients with acute brain injury who need emergency surgery have better CT results. MRI (Nuclear Magnetic Resonance) Due to the long examination time, those with severe illness should not accept this examination. Those with metal foreign bodies in the head trauma can not be scanned. MRI is an important supplement for patients with more stable conditions. Multi-directional scanning can show more and more accurate lesions. [2]

Craniocerebral trauma III. Principles of treatment

1 Traumatic brain injury 1. debridement

It should be carried out within 6 hours after the injury, and it can be extended to 72 hours after the injury with the use of effective antibiotics. If the patient has shock, it should be corrected first, especially in children and the elderly. Debridement should be performed from shallow to deep, removing broken and inactive tissues and foreign bodies layer by layer, carefully removing loose bone fragments, and removing the foreign bodies embedded in the skull under direct vision.

For open craniocerebral injury that occurs 4 to 6 days after injury due to late or incomplete debridement at the early stage of treatment, and there are signs of infection in the wound, thorough debridement should not be performed. The wound should be cleaned, drainage conditions improved, and sensitive antibiotics selected Infection; when the wound secretion is reduced and the granulation grows well, when the local bacterial culture is negative for three consecutive times, the scalp wound can be sutured with full-thickness reduction and left for drainage for 2 to 3 days. The drainage time can be extended if necessary. For advanced wounds that have been severely infected for more than 7 days, the wound can only be simply expanded to facilitate drainage and be further treated after the infection is controlled.

2 Craniocerebral trauma 2. Treatment of brain injury

Open degenerative brain injury is converted to closed head injury after debridement, and treatment is based on the principle of closed injury treatment, including prevention and treatment of cerebral edema, anti-infection, and promotion of neurological recovery.

Craniocerebral trauma

Rehabilitation nursing is divided into two phases: rehabilitation nursing in the acute phase and rehabilitation nursing in the stable phase.

1 Traumatic brain injury 1. Rehabilitation nursing in acute phase

(1) Maintain a reasonable posture

In the early stage of traumatic brain injury, patients often need to be strictly bedridden due to the illness, but most patients cannot complete the position conversion by themselves. From the first day of admission, care should be taken to place the patient in bed. This period emphasizes the use of three different supine positions, including supine, affected, and uninjured.

(2) Awakening therapy

Patients with severe craniocerebral injury will have coma or lethargy of varying lengths of time. In addition to applying drugs to reduce intracranial pressure and improve intracranial blood circulation, confidence stimulation methods are often used, including music therapy, loved ones calling, and passive limbs. Massage, skin massage, acupuncture, etc.

2 Craniocerebral trauma 2. Rehabilitation nursing in stable period

(1) Psychological rehabilitation nursing

Patients with craniocerebral injury have a high disability rate and prolonged bed rest. In addition, the patients are mostly young and middle-aged, and there is a huge contrast between post-traumatic and pre-traumatic. encourage.

(2) Rehabilitation nursing for motor function

It mainly includes joint mobility training and posture change training. Joint mobility training is sequential training from the proximal joint to the distal joint. Two groups are done every day, each joint is about 10 times. Posture change training refers to the bedside elevation of 30 °. After the patient's maximum time is more than 30min, the bedside is increased by 10 ° the next day and then trained until it can be maintained at 90 ° and more than 30min. Later, the bedside will be trained 2, the affected side sit-up exercises.

(3) Rehabilitation nursing for cognitive function

Rich environment is one of the effective methods to promote the recovery of cognitive dysfunction after traumatic brain injury. It mainly includes four training methods of memory, comprehensive analysis ability, writing and calculation.

(4) Language function rehabilitation nursing

Traumatic brain aphasia is divided into three types: motor, sensory and complete aphasia. The earlier the rehabilitation training time after injury, the better the effect.

(5) Rehabilitation nursing for daily living ability

Including training for putting on and taking off clothes, washing, eating, personal hygiene, toileting, etc., assisted by others to complete it independently, step by step, so that patients can take care of themselves or reduce their dependence on life to a minimum, so that they can use it alone or with minimal Assist in daily activities and gradually move to the community for social activities. [3]