HEAD INJURY (GENERAL) TrH1 (1) Head Injury (GENERAL) Last updated: December 19, 2020 DEFINITIONS, CLASSIFICATIONS ............................................................................................................. 2 EPIDEMIOLOGY ........................................................................................................................................ 2 Incidence ............................................................................................................................... 2 Morbidity ............................................................................................................................... 2 Mortality ................................................................................................................................ 2 ETIOLOGY ................................................................................................................................................ 2 PATHOPHYSIOLOGY (PRIMARY VS. SECONDARY INJURY) ..................................................................... 3 PRIMARY BRAIN INJURY ......................................................................................................................... 3 Mechanisms ........................................................................................................................... 3 SECONDARY BRAIN INJURY .................................................................................................................... 3 PATHOPHYSIOLOGY (CEREBRAL BLOOD FLOW, EDEMA) ..................................................................... 3 PATHOPHYSIOLOGY (BIOCHEMISTRY) ................................................................................................... 4 PATHOLOGY, CLINICAL FEATURES ........................................................................................................ 4 CONCUSSION .......................................................................................................................................... 5 DIFFUSE AXONAL INJURY (DAI) ........................................................................................................... 6 CONTUSION AND LACERATION............................................................................................................... 6 INTRACEREBRAL HEMORRHAGE (TRAUMATIC ICH, TICH) .................................................................... 9 MISSILE (GUNSHOT) INJURY .................................................................................................................. 9 Self-inflicted injuries ........................................................................................................... 12 STAB INJURY (IMPALEMENT) ............................................................................................................... 12 COMPRESSION INJURY ......................................................................................................................... 13 DEGREES OF SEVERITY .......................................................................................................................... 13 PREHOSPITAL MANAGEMENT ................................................................................................................ 14 1. Oxygenation .................................................................................................................... 14 2. Blood Circulation ............................................................................................................ 14 3. Cervical Spine Stabilization ............................................................................................ 15 4. Brief Neurologic Status ................................................................................................... 15 5. Transportation ................................................................................................................. 15 DIAGNOSTIC EVALUATION .................................................................................................................... 15 Diagnosis in Latin ............................................................................................................... 15 HISTORY .............................................................................................................................................. 15 PHYSICAL EXAMINATION ..................................................................................................................... 15 IMAGING .............................................................................................................................................. 16 Imaging modalities ......................................................................................................................... 16 CT without contrast ............................................................................................................. 17 Plain skull radiographs ........................................................................................................ 18 Nonenhanced MRI .............................................................................................................. 18 Angiography ........................................................................................................................ 19 Ultrasonography .................................................................................................................. 19 Conditions ...................................................................................................................................... 19 Concussion .......................................................................................................................... 19 Diffuse axonal injury ........................................................................................................... 19 Scalp Injuries ....................................................................................................................... 20 Contusion ............................................................................................................................. 20 Penetrating injuries .............................................................................................................. 21 OTHER NEUROLOGIC TESTS ................................................................................................................. 22 NON-NEUROLOGIC TESTS .................................................................................................................... 22 MANAGEMENT ....................................................................................................................................... 22 DISPO ................................................................................................................................................... 23 Hospitalization ..................................................................................................................... 23 Transfer ............................................................................................................................... 23 ABC .................................................................................................................................................... 23 Airway, Ventilation ........................................................................................................................ 23 Blood pressure ................................................................................................................................ 23 Resuscitation fluids ............................................................................................................. 23 GENERAL MEASURES ........................................................................................................................... 24 Regimen, Activity ............................................................................................................... 24 Nutritional Support .............................................................................................................. 24 DVT prophylaxis ................................................................................................................. 24 Hemoglobin ......................................................................................................................... 24 NEUROLOGICAL MEASURES ................................................................................................................. 24 ICP management ............................................................................................................................ 24 Monitoring ........................................................................................................................... 24 Treatment ............................................................................................................................. 25 CPP ................................................................................................................................................. 27 Advanced brain oxygenation / metabolic status monitoring .......................................................... 27 Oximeters ............................................................................................................................ 27 TCD ..................................................................................................................................... 28 Microdialysis 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