NURSING CARE RELATED TO THE SENSORY AND
NEUROLOGICAL SYSTEMS
2-39
Section VIII. HEAD AND SPINE INJURIES
2-39. HEAD INJURIES
a. Direct and Indirect Head Injuries. Head injuries are generally categorized as direct and indirect.
(1) Direct injuries result from a direct blow to the head.
(2) Indirect injuries result from the brain being jarred against the interior of the skull.
(3) Coup-contrecoup. This phenomenon is a combination of direct and indirect injury. A direct blow to one side of the skull causes the brain to be jarred inside the skull, causing an indirect injury on the side opposite the direct blow.
b. Brain Damage. Brain damage resulting from a head injury is dependent upon:
(1) The force of impact.
(2) The type of impact.
(3) The location of impact.
c. Skull Fractures. A skull fracture is a break in the continuity of the skull bones or a separation of the sutures.
(1) Basilar skull fractures are potentially serious injuries due to the proximity of the brain stem.
(2) Depressed skull fractures may be open or closed. In either case, the underlying brain tissue may be damaged.
(3) Linear skull fractures are "cracks." They may be dangerous if they overlie vascular structures.
d. Hematomas. Hematomas are a result of bleeding within the closed compartment of the skull. They may cause compression of brain tissue.
(1) Epidural hematoma is caused by bleeding between the skull and the dura.
(2) Subdural hematoma is caused by bleeding between the dura and the arachnoid membrane.
(3) Subarachnoid hemorrhage/hematoma is caused by bleeding into the subarachnoid space.
e. Concussion. Concussion results from violent jarring of the brain against the interior of the skull. The patient experiences a brief loss of consciousness followed by confusion, headache, and irritability. Complete recovery is usual.
f. Contusion. This injury is more serious than a concussion. The severe jarring of the brain causes bruising of the brain. (This bruising is the result of blood vessel rupture.) Permanent damage may result.
