Head trauma is caused by a sudden force hitting the head, causing injury to the brain. Brain trauma can either be an effect of the head forcefully hitting a hard object (closed head trauma) or when a penetrating object punctures the skull and affects the brain (penetrating head trauma). Head trauma can be classified according to the severity of injury: mild, moderate and severe.
The management of head trauma depends on the type of injury, either closed head trauma or penetrating head trauma. Closed head trauma is divided into the treatment of mild head trauma and treatment of moderate to severe head trauma.
MILD HEAD TRAUMA
Mild head trauma may not necessitate prolonged hospitalization and radiographic evaluation. No treatment is required and the physician usually prescribes over-the-counter medications to relieve the headache. However, assessment and monitoring are required to verify any underlying symptoms. Discharge may immediately follow as long as someone can watch over the patient while recovering at home. A discharge care instruction checklist is handed out. Included in the instructions is ensuring that the patient’s neurological status should be observed every 2 hours. If there is a development of persistent or new symptoms, such as chronic headache, confusion or dizziness, nausea and vomiting and clear watery nasal and auditory discharge, care providers should immediately seek a professional medical advice.
It is also advised that the patient return for follow-up check-up. The physician will instruct on the appropriate activity routine during the recovery period. To lessen the severity of symptoms, it is highly recommended to avoid strenuous physical and mental exertions.
MODERATE TO SEVERE HEAD TRAUMA
On a much more serious case of head trauma, the main goal of the immediate care is to ensure that the patient has normal oxygenation, blood supply and blood pressure and no further trauma inflicted to the head.
The initial step to manage moderate to severe head trauma is to stabilize the cardiopulmonary function of the body. It is essential that hypoxia and hypotension are avoided during the first phase of treating the head injury. Patients who have showed signs of hypoxia and hypotension early on have higher mortality rates than those who don’t.
After cardiopulmonary resuscitation has been done, neurologic assessment follows. This evaluation can be executed through the use of the GCS scoring and neurologic examination. CT scan is performed to check for any need to perform surgery. Before, it is believed that restricting fluid intake aided in the management of head trauma in order to prevent the progression of increased intracranial pressure and cerebral edema. However, restriction of fluids results to decreased cardiac output due to lowered intravascular volume. This may lead to decreased cerebral blood flow and perfusion, thereby may help in the formation of cerebral edema and ICP. Therefore, restriction of fluid intake is not recommended.
It is important to elevate the head of the bed by 20-30° to reduce the likelihood of increased ICP. Provide adequate rest periods to help the brain recover from the injury. It is also necessary to conduct close ICP monitoring.
PENETRATING BRAIN TRAUMA
The management of penetrating brain trauma, with increased ICP caused by penetrating objects, is similar to the management of closed head trauma. Surgery is necessary to remove the penetrating object or relieve increased intracranial pressure. Penetrating brain trauma is highly susceptible to infection introduced by the penetrating object. Proper debridement and irrigation is done to prevent infection. ICP monitoring is still carried out. Fluid resuscitation follows to maintain normal oxygen level.