Critical Care of Head Injury

Most people know someone affected by a head injury. Maybe that person is a child who fell from a playground swing or a football player who experienced a severe blow to the head. From the athlete who experiences a mild concussion to the driver involved in a major accident with a severe injury, traumatic brain injury can be found all around us. It is the leading cause of death and disability in patients from ages 1 to 44 years.

What is critical is the critical care of head injury?

Critical care of head injury case

Consider this case: a seven-year-old child was taken for an appointment to his pediatrician. During the visit, the plaintiff’s mother told the doctor the child had been hit on the head recently with a golf club. The doctor opined the child would be alright. The child died the next day. The plaintiff claimed the child should have been referred for a CT scan. The defendant denied negligence. The jury in this Alabama case reached a defense verdict. Dunham v. Tyler, Tallapposa County (AL) Circuit Court, Case Mo. 09-900059, reported in 2014.

There is no additional information about why the jury felt the pediatrician was not negligent.

Causes of head injury

Head injuries can come from many sources. They are classified into primary and secondary injuries. Primary injuries, or the initial insult, can be either focal or global. Some examples of primary injury are:

• Motor vehicle accidents
• Falls
• Gunshot wounds
• Assault
• Stabbings

Secondary injuries occur as a direct result of the primary injury and can have serious implications on neurologic outcome and mortality. Some examples of secondary injury are:

• Brain swelling
• Increased intracranial pressure
• Decrease in level of consciousness
• Pupil changes
• Changes to the patient’s motor function

Key components of critical care of head injury

How does the modern intensive care unit staff respond to detect these changes and reduce the damage? We must control the intracranial pressure (ICP) and enhance cerebral blood flow to limit the secondary damage.

In addition to the neurologic exam, the medical team can utilize advanced neuro-monitoring techniques that give the bedside clinician a better understanding of the patient’s ICP. The bedside nurse can also employ both simple and complex techniques to keep the patient’s ICP under control to maximize blood flow to the injured brain. What are these techniques and what is the standard of care?

Whether you are new to the world of brain injury or an experienced clinician, this brief overview is for you. Come join us for a session that plans to fill your brain and not damage it! Join us for the full Falls Course.

Scott Rajnic BSN RN CCRN RN is an American Association Critical Care Nurses trained CCRN (certified critical registered nurse) with over 20 years of ICU bedside experience in a Level 1 Trauma center. The Level 1 trauma center is the last stop for critically ill patients involved in falls, motor vehicle accidents or other mechanisms of injury. It’s where the most advanced care can be found. Throughout that time, he has been focused on the care of those involved in all forms of trauma that require intensive care. He is also involved in training new graduate nurses to become critical care nurses. Scott is a critical care expert witness through www.medleague.com and president of Insight Legal Nurse Consulting.