injuries and poisoning
Overview of Head Injuries
Treatment of Head Injuries
For minor head injuries, treatment of symptoms For severe head injuries, treatment to maintain vital functions and to limit complications If a head injury is minor and causes no symptoms other than pain at the site of injury, mild analgesics such asacetaminophenmay be used.Aspirinor any other nonsteroidal anti-inflammatory drug should not be taken because these medications may worsen any bleeding in the brain or skull. Doctors use stitches (sutures) or medical staples to close cuts and then apply gauze or bandages. If people did not lose consciousness or lost it only briefly and if their examination results are normal, they may be discharged home as long as a family member or friend can check them for certain symptoms every few hours during the first 24 hours after the injury. The family member or friend should bring them to the hospital if any of the following potentially serious symptoms develop: Reduced alertness and awareness of the surroundings Problems with vision, hearing, or walking Numbness or paralysis of a body part A headache that is getting worse Vomiting Deterioration of mental function (such as becoming confused, not being able to recognize people, or behaving abnormally) Seizures If people have lost consciousness for longer than a few moments or have abnormal examination results, they are usually kept in the emergency department or hospital for observation. Children who have had a minor head injury may be allowed to sleep, but they should be awakened every few hours and checked for symptoms. People, including children, are admitted to the hospital if doctors suspect brain damage based on symptoms or CT findings. Children are also admitted to the hospital if they were unconscious even briefly or had a Seizure Disorders or if Acetaminophenis the best analgesic to take after a minor head injury. If the injury may affect other parts of the body (for example, after a motor vehicle crash) or if the person is unconscious, an ambulance should be called. When emergency personnel are moving a person who has had a severe head injury, they take great care to avoid making the injuries worse. The neck should be assumed to be broken until proved otherwise. In such cases, the person’s head, neck, and spine are stabilized. Usually, the person is put in a hard neck collar, strapped to a firm board, and carefully padded to prevent movement. People with severe head injuries are admitted to the hospital, usually to an intensive care or critical care unit. The first priority is to keep blood pressure and levels of oxygen and carbon dioxide in the blood at desirable levels. If the head injury is severe, the areas of the brain that control breathing may be affected. Also, the reflex that protects the windpipe (trachea) may not be functioning. (This reflex prevents saliva and other substances in the mouth from being inhaled.) For these reasons, a breathing tube is usually inserted through the mouth into the windpipe to help people breathe while doctors treat other problems, such as swelling in the brain. If the head injury is very severe, Mechanical Ventilation may be used. Doctors control blood pressure and minimize the amount of brain swelling by adjusting the amount of intravenous fluids given and sometimes by giving intravenous drugs that increase fluid excretion (diuretics, such asmannitolandfurosemide) or a concentrated salt solution (hypertonic saline). The concentrated salt solution may help minimize brain swelling more effectively than diuretics. Managing oxygen and carbon dioxide levels in the blood can help relieve pressure within the skull caused by swelling and ensure that the brain is getting enough oxygen. Doctors can control these levels by adjusting the amount of oxygen given and the rate and depth of breaths given by the ventilator. The head of the bed may be raised to prevent excessive pressure within the skull and brain. A small pressure gauge may be implanted inside the skull to measure pressure within the skull and to determine how well the treatments are preventing or treating pressure elevation within the brain. Alternatively, a catheter may be inserted into one of the spaces (ventricles) within the brain. The ventricles contain cerebrospinal fluid, which flows over the surface of the brain between the layers of tissue that cover the brain (meninges). The catheter can be used to monitor the pressure and to drain cerebrospinal fluid, reducing the pressure within the skull. Sometimes doctors need to surgically remove a large piece of the skull to relieve the pressure; the piece of skull is replaced after the swelling goes down. In a person with a severe head injury, the neck should not be moved because it may be broken. Pain is treated. Opioid pain relievers may be needed. People may need to be sedated because too much muscle activity can be harmful. Fever is treated. If seizures occur, anticonvulsants are given. Doctors closely monitor the function of other organs, such as the kidneys, heart, lungs, and intestine because severe head injury can impair function of those organs. 