What can happen during a head injury

Head injury can range in severity from mild to severe. A primary brain injury occurs at the time of the injury. This is from the direct impact of the mechanism. Secondary brain injury occurs following the primary event as a result of hypoxia, hypercarbia, or hypoperfusion.

A further deficit can occur through other factors such as the patient being unconscious and having a poor/occluded airway, having a catastrophic haemorrhage and hypoperfusion, and so on.

Ranges of injury can vary, a patient may have a concussion or mild brain injury where a bang or jolt to the head can cause the brain to bounce or twist in the skull. This can create some chemical changes in the brain, and sometimes stretching and damaging brain cells. More severe injury can develop to contusions, hematomas, skull fractures, subarachnoid and intracranial haemorrhage. These injuries can cause an increase in ICP which can further develop into more brain injury through brain herniation and coning.

There are a great number of red flags or concerns for a head injury which can help to identify if the injury is of greater potential severity and risk. These can include but are not limited to;

GCS <15 on initial assessment

Any LOC as a result of injury

Any focal neurological deficit since the injury

Any suspicion of skull fracture or penetrating head injury

Amnesia of the events before or after injury

Any vomiting episodes since the injury

Any seizures since the injury

Any previous brain surgery

High energy head injury

History of bleeding or clotting

Current anticoagulant therapy

Drug or alcohol intoxication

Safeguarding concerns