Head Trauma Overview and Practice Questions Vector

Head Trauma: Overview and Practice Questions (2024)

by | Updated: Feb 6, 2024

Head trauma is a critical medical concern that can have profound and lasting effects on an individual’s health and well-being.

Whether caused by accidents, sports injuries, or other incidents, head trauma poses significant risks to the brain and overall bodily function.

In this article, we will delve into the significance of head trauma, its potential consequences, and the importance of early intervention and prevention.

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What is Head Trauma?

Head trauma refers to any injury or damage inflicted on the brain due to a physical blow, jolt, or impact to the head. It can result from accidents, falls, sports injuries, or violent incidents. Head trauma can range from mild concussions to severe brain injuries, with symptoms and consequences varying widely depending on the severity of the injury.

Head Trauma Injury Vector Illustration

Types

Head trauma can be classified into several types, primarily based on the nature of the injury:

  • Concussion: A mild brain injury that temporarily affects brain function, often caused by a blow to the head.
  • Contusion: A bruise (bleeding) on the brain, which can be caused by a direct impact to the head.
  • Cerebral Laceration: Tearing of brain tissue, often associated with severe head injuries.
  • Diffuse Axonal Injury (DAI): Caused by shaking or strong rotation of the head, leading to tearing of brain structures and widespread brain damage.
  • Traumatic Subarachnoid Hemorrhage: Bleeding into the space surrounding the brain, often due to a significant head injury.
  • Epidural Hematoma: Bleeding between the dura mater and the skull, typically due to arterial injury, causing a build-up of pressure on the brain.
  • Subdural Hematoma: Bleeding under the dura mater, which can increase pressure on the brain and is usually caused by veins rupturing due to a severe head injury.
  • Skull Fracture: A break in one or more of the bones in the skull, often caused by a blow to the head.
  • Penetrating Injury: An injury where an object breaks through the skull and enters the brain.

Note: Each type of head trauma can vary widely in severity and potential complications, necessitating tailored medical assessment and intervention.

Causes

Head trauma is commonly caused by a variety of incidents and conditions, including:

  • Falls: This is one of the most common causes, especially in children and the elderly, involving falls from beds, stairs, bathrooms, ladders, or as a result of a slip.
  • Motor Vehicle Accidents: Collisions involving cars, motorcycles, bicycles, and pedestrians can result in severe head injuries.
  • Violence: Assaults, domestic violence, gunshot wounds, and other forms of physical altercations can cause head trauma.
  • Sports Injuries: Contact sports like football, boxing, hockey, soccer, skateboarding, and other high-impact or extreme sports can lead to head injuries.
  • Explosive Blasts and Combat Injuries: Military personnel are at risk from blasts caused by explosive devices, which can result in traumatic brain injuries.
  • Workplace Accidents: Occupational hazards, especially in construction and industrial settings, can cause head injuries due to falls, struck-by incidents, or equipment malfunctions.
  • Child Abuse: This is a tragic cause of head trauma in young children, particularly in the form of shaken baby syndrome.

Note: Understanding these causes is essential for developing strategies to prevent head trauma and reduce its incidence.

Signs and Symptoms

The signs and symptoms of head trauma can vary greatly depending on the severity of the injury and the area of the brain affected.

They can be immediate or delayed, with some appearing only days after the incident. Common signs and symptoms include:

Physical Symptoms

  • Loss of consciousness, which may be brief or prolonged
  • Headache, which can range from mild to severe
  • Nausea or vomiting
  • Drowsiness or fatigue
  • Problems with speech
  • Dizziness or loss of balance
  • Visual disturbances such as blurred vision, seeing stars, or light sensitivity
  • Clear fluids draining from the nose or ears (which could indicate a skull fracture)

Cognitive or Mental Symptoms

  • Confusion or disorientation
  • Memory problems or amnesia
  • Difficulty concentrating or processing information
  • Mood changes or swings
  • Depression or anxiety

Sensory Symptoms

  • Ringing in the ears (tinnitus)
  • Changes in the ability to smell
  • Sensitivity to light and sound

Motor Symptoms

  • Weakness or numbness in the fingers and toes
  • Coordination problems
  • Seizures

Sleep Disturbances

  • Sleeping more than usual
  • Difficulty sleeping

Note: It’s important for individuals to seek immediate medical attention if any of these symptoms are present following a head injury, as some symptoms may signify a more serious condition that requires urgent care.

Treatment

Treatment for head trauma is tailored to the specific type and severity of the injury and may involve a multi-disciplinary approach.

Here’s an outline of possible interventions:

  • Immediate Emergency Care: Ensuring an open airway, maintaining breathing, and stabilizing the cervical spine are critical first steps in the emergency setting.
  • Observation: For mild injuries like concussions, close monitoring for any progression of symptoms is often required.
  • Medications: This includes pain relievers for headaches (e.g., acetaminophen), anti-seizure drugs for those at risk of seizures, diuretics if there is brain swelling, and sedatives for restlessness or agitation.
  • Surgery: Removing blood clots (hematomas) that may form and press against the brain, repairing skull fractures, relieving pressure inside the skull by drilling a hole or creating a window in the skull, and removing parts of the skull to allow a swelling brain to expand without being squeezed
  • Rehabilitation: Physical therapy to regain muscle strength and coordination, occupational therapy to relearn everyday skills, speech and language therapy to improve communication, and psychological counseling or therapy to cope with emotional and behavioral changes.
  • Rest and Gradual Return to Activities: Allowing the brain to heal by avoiding physical and cognitive activities that could exacerbate symptoms.
  • Prevention of Secondary Damage: Includes managing other medical issues that may arise, such as infections, and monitoring for secondary brain injury due to inflammation, bleeding, or reduced oxygen supply to the brain.
  • Long-Term Care: For severe injuries, long-term treatment plans, including specialized facilities or home care arrangements, may be necessary.

Note: The timely administration of appropriate treatment is crucial and can significantly influence the patient’s recovery and long-term outcome.

Treating Head Trauma as a Respiratory Therapist

Respiratory therapists play a crucial role in the interdisciplinary team managing patients with head trauma. Their primary focus is on ensuring adequate ventilation and oxygenation, which are vital for the brain’s recovery.

Here’s how an RT may be involved in treating head trauma:

  • Airway Management: RTs assess and maintain a patent airway. In cases of severe head trauma, this might involve assisting with intubation or providing noninvasive ventilatory support.
  • Mechanical Ventilation: If the patient is unable to breathe unaided or needs sedation for other procedures, RTs manage the ventilator settings to ensure optimal oxygen delivery while minimizing the risk of lung injury.
  • Blood Gas Analysis: Monitoring arterial blood gases is essential for evaluating the patient’s respiratory status and the need for adjustments in ventilator settings or supplemental oxygen.
  • Oxygen Therapy: Administering the correct level of supplemental oxygen to maintain targeted oxygen saturation levels without causing oxygen toxicity.
  • Pulmonary Hygiene: Implementing chest physiotherapy, suctioning, and other techniques to prevent atelectasis and pneumonia, which are common complications in immobile patients with head injuries.
  • Weaning and Extubation: RTs assess readiness for weaning from mechanical ventilation and assist with the weaning process, providing support during the transition back to spontaneous breathing.
  • Neuroprotective Strategies: Collaborating with the medical team to implement strategies that may include hyperventilation to lower intracranial pressure (ICP) when clinically indicated.
  • Education and Rehabilitation: Educating the patient and family about the ventilatory support and rehabilitation process, including breathing exercises and strategies to improve lung function after extubation.
  • Collaboration with the Care Team: Working with physicians, nurses, and other healthcare professionals to develop and adjust treatment plans based on the patient’s evolving condition.
  • Emergency Response: Being prepared to respond to emergencies, such as acute changes in respiratory status or ventilator alarms, and to assist with resuscitation if necessary.

Note: Throughout all these responsibilities, the respiratory therapist must be vigilant in monitoring for signs of respiratory distress or changes in neurological status, always considering the unique needs of patients with head trauma.

What is a Traumatic Brain Injury?

A traumatic brain injury (TBI) is a form of head trauma that results from a bump, blow, jolt, or penetration to the head that disrupts normal brain function.

They can range in severity from mild, commonly referred to as concussions, to severe, where extensive damage can lead to prolonged unconsciousness or amnesia after the injury.

TBIs can lead to a wide range of short- or long-term issues affecting cognitive function, motor skills, sensation, and emotion. The impact of a TBI can include physical disabilities, changes in personality, emotional distress, and cognitive impairment.

The treatment and outcome of TBI can vary widely depending on the severity of the injury and the individual’s condition.

What is the Glasgow Coma Scale?

The Glasgow Coma Scale (GCS) is a clinical tool commonly used to assess the level of consciousness and neurological functioning in individuals who have suffered head injury or are otherwise affected by various medical conditions.

Developed by neurosurgeons Graham Teasdale and Bryan J. Jennett at the University of Glasgow in 1974, the scale is designed to be simple, objective, and reliable for evaluating the conscious state of a patient.

The GCS evaluates three aspects of a patient’s responsiveness:

Eye Opening (E)

  • Spontaneous: 4 points
  • To verbal command: 3 points
  • To pain: 2 points
  • No eye opening: 1 point

Verbal Response (V)

  • Oriented: 5 points
  • Confused conversation: 4 points
  • Inappropriate words: 3 points
  • Incomprehensible sounds: 2 points
  • No verbal response: 1 point

Motor Response (M)

  • Obeys commands for movement: 6 points
  • Purposeful movement to painful stimulus: 5 points
  • Withdraws from pain: 4 points
  • Flexion to pain (decorticate response): 3 points
  • Extension to pain (decerebrate response): 2 points
  • No motor response: 1 point

The GCS score is the sum of these three components, with a minimum score of 3 (deep unconsciousness, often coma) and a maximum of 15 (fully awake and aware).

Scores of 8 or below generally indicate severe brain injury and a state of coma. The GCS is used extensively in the field of emergency medicine, critical care, and neurology.

Note: While the GCS is a useful tool for initial and serial assessment, it does not substitute for a more detailed neurological examination and should be considered in the broader context of the patient’s clinical picture.

Head Trauma Practice Questions

1. What is the definition of a traumatic brain injury?
A traumatic brain injury is a disruption in normal brain function caused by an external mechanical force to the head, resulting in temporary or permanent impairment of cognitive, physical, and psychosocial functions.

2. What is the epidemiology of a traumatic brain injury?
It occurs in males twice as often as in females.

3. What is the equation for cerebral perfusion pressure?
CPP = MAP – ICP

4. What is the Glasgow Coma Scale?
The Glasgow Coma Scale is a clinical tool designed to assess and score a person’s level of consciousness after a head injury by measuring their verbal, motor, and eye-opening responses to stimuli.

5. What is head trauma characterized by?
Head trauma is characterized by any injury to the brain, skull, or scalp, resulting from impact, sudden motion, or penetration, with potential effects on cognitive and neurological function.

6. What are the clinical presentations of head trauma?
Headache, amnesia, and loss of consciousness.

7. What is the diagnosis of head trauma?
CT scans without contrast are one way to diagnose brain injury. Also, cervical spine x-rays can be considered if there are focal neuro deficits with cervical radiculopathy.

8. What are the effects of head trauma?
Traumatic brain Injury (TBI), tumors, aneurysms, cerebrovascular accidents (CVA), and seizures.

9. What happens after head trauma?
Trauma to the brain causes hemorrhage and edema, while “closed head” traumatic brain injury may lead to tissue swelling and increased ICP.

10. What are the effects of increased intracranial pressure (ICP)?
Decreased cerebral blood flow, secondary ischemia, and prolonged cerebral ischemia that can lead to death.

11. What past medical history do patients with head trauma typically have?
Tumors, headaches, cranial bleeds, trauma, seizures, hemiparalysis, which is paralysis on one side, slurred speech, the respiratory pattern is irregular (i.e., bradypnea or Cheyne stokes), level of consciousness shows altered breathing, and an abnormal pupillary response.

12. What special tests are performed on a head trauma patient?
The Glasgow Coma Score and imaging tests, such as CT, MRI, and PET Scan.

13. What forms of mechanical ventilation should be used for head trauma patients?
Decrease the patient’s PaCO2 to 25-30 if you’re worried about their ICP, avoid hypercapnia, minimize mean airway pressures (i.e., decrease Vt, change RR, decrease PEEP), and set low pressure and exhaled volume alarms.

14. What medications should be given to head trauma patients?
Fluid resuscitation and vasopressors to keep MAP less than 75 mmHg, barbiturates for sedation, Dilantin (Phenytoin) for seizures, mannitol to decrease ICP, and hypertonic Saline for posturing, unequal or non-reactive pupils.

15. What should you monitor for patients with a head injury?
Arterial BP through A-line, ICP 15-20, cerebral perfusion pressure (CPP) greater than or equal to 60, and SpO2 greater than 95%.

16. What are some methods to decrease ICP?
Decrease ICP by elevating the head of the bed 30-40 degrees, administering Benzodiazepine or propofol, Ativan, Xanax, etc., and neuromuscular blocking agents.

17. What is a head injury?
A broad classification that includes any trauma to the scalp, skull, or brain.

18. What are the primary causes of head injury?
Motor vehicle crashes and falls are the most common causes of. Other causes include firearms, assaults, sports-related trauma, and recreational injuries. Males are twice as likely to sustain a TBI as females.

19. Deaths from head trauma occur at what three time points after an injury?
Immediately after injury, within 2 hours of the injury, and approximately 3 weeks after the injury.

20. When do the majority of deaths occur after a head injury?
The majority of deaths occur immediately after the injury, either from direct head trauma or massive hemorrhage and shock.

21. What are the primary types of head injuries?
Scalp lacerations and skull fractures.

22. What are scalp lacerations significant?
Because the scalp contains many blood vessels with poor constrictive abilities, even relatively small lacerations can bleed profusely. The major complications of scalp lesions are blood loss and infection.

23. What is a skull fracture?
A skull fracture is a break in one or more bones of the skull, often resulting from blunt force trauma or impact to the head.

24. What are the types of skull fractures?
Linear, depressed, comminuted, and basilar.

25. What is a diffuse injury?
A diffuse injury is a type of brain injury that involves widespread damage to the brain’s white matter, typically resulting from a rapid acceleration or deceleration of the head.

26. What are the signs of a diffuse injury?
Brief disruption in LOC, amnesia for the event (i.e., retrograde amnesia), and headache. Manifestations are generally of short duration.

27. What is post-concussion syndrome?
May develop in some patients after a diffuse injury and is usually seen anywhere from two weeks to two months after the concussion.

28. What are post-concussion symptoms?
Persistent headache, lethargy, behavior changes, decreased short-term memory, and changes in intellectual ability.

29. What needs to be done during diffuse injury discharge?
At the time of discharge, it is important to give the patient and caregiver instructions for observation and accurate reporting of symptoms or changes in neurologic status.

30. What is a laceration?
In the context of head trauma, a laceration refers to a tear in the brain tissue, often caused by a penetrating head injury, which can lead to bleeding and other brain damage.

31. What is a contusion?
A contusion in the context of head trauma is a bruise on the brain tissue, often resulting from a direct impact to the head, which can cause bleeding and swelling in the affected area.

32. When major head trauma occurs, what delayed responses may be seen?
Hemorrhage, hematoma formation, seizures, and cerebral edema.

33. What are the complications of a TBI?
Epidural hematoma, subdural hematoma, and intracerebral hematoma.

34. What is an epidural hematoma?
It results from bleeding between the dura and the inner surface of the skull. It’s a neurologic emergency and is usually associated with a linear fracture crossing a major artery in the dura, causing a tear. It can have a venous or an arterial origin.

35. What is an arterial hematoma in a head injury?
The middle meningeal artery lying under the temporal bone is frequently torn. Because this is an arterial hemorrhage, the hematoma develops rapidly.

36. What is another name for a serious form of a head injury?
Traumatic brain injury.

37. What is a rule of thumb to remember about head trauma?
It refers primarily to craniocerebral trauma, which includes an alteration in consciousness, no matter how brief.

38. What does the Glasgow Coma Scale measure?
The Glasgow Coma Scale measures a person’s level of consciousness and neurological functioning after a head injury, based on their verbal, motor, and eye-opening responses to stimuli.

39. What does the Glasgow Coma Scale assess?
It assesses the functional state of the brain as a whole. It is possible, over time, to plot the score on a timeline to see if the person is stable, improving, or deteriorating.

40. What does the LOC assess?
Arousal, wakefulness, awareness, and orientation.

41. When is a patient considered alert and fully conscious?
Readily aroused, fully aware, and responds appropriately without delay.

42. When is a patient considered lethargic?
Slow, sluggish, may be somewhat disorientated and agitated but follows simple commands with decreased movement and fuzzy thinking.

43. When is a patient considered obtunded?
The patient is difficult to arouse, sleeps most of the time, has marginal cooperation, is mumbling, incoherent, and acts confused when aroused.

44. When is a patient considered stupor or semi-comatose?
When a response requires very vigorous tactile stimuli, the patient makes incomprehensible sounds, only groans, and the patient responds to pain by withdrawing a body part.

45. When is a patient considered comatose?
When they are completely unconscious with no response to pain or external stimuli.

46. What is a major focus for respiratory therapists when treating a patient with a traumatic brain injury?
Their intracranial pressure

47. What medication can be administered to decrease intracranial pressure?
Mannitol

48. Can head trauma cause cardiac arrest?
Yes, severe head trauma can potentially lead to cardiac arrest, particularly if it involves the brainstem or disrupts the brain’s autonomic pathways that control heart function.

49. What are the five danger signs of a head injury?
Loss of consciousness or deteriorating consciousness, seizures or convulsions, repeated vomiting, unequal pupil size or non-reactive pupils, and clear fluid leaking from the nose or ears, indicating a possible skull fracture.

50. What is the number one sign of a head injury?
The number one sign of a head injury is typically a change in level of consciousness, ranging from full alertness to drowsiness, disorientation, or complete unresponsiveness.

Final Thoughts

Head trauma is a serious issue that demands immediate attention and proper management.

The potential consequences of untreated or inadequately addressed head injuries can be severe, impacting not only physical health but also cognitive and emotional well-being.

By prioritizing awareness, prevention, and timely medical intervention, we can take significant steps toward reducing the burden of head trauma and improving the lives of those affected by it.

John Landry, BS, RRT

Written by:

John Landry, BS, RRT

John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.

References

  • Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019.
  • Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
  • Shaikh F, Waseem M. Head Trauma. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
  • Georges A, M Das J. Traumatic Brain Injury. [Updated 2023 Jan 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
  • Jain S, Iverson LM. Glasgow Coma Scale. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.

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