Emergency Management of Head Injury

Abstract

Head injury is a common occurrence and a serious health problem (1), accounting for 2% of all deaths and 26% of injury deaths reported in the United States (2). Head injury is one of the most significant components in multiple trauma and is among the most serious causes of long-term morbidity. Sixty to seventy percent of all motor vehicle accidents result in some type of head injury. Blunt head injuries rarely occur as an isolated event; there are associated injuries in most cases, the most significant being those to the cervical spine, and the most common being extremity injuries. Associated injuries may be difficult to detect because of the impaired mental status of the head-injured patient. Clinically, the most important historical symptom of head injury is loss of consciousness, because this correlates best, although very roughly, with the forces involved. The duration of both retrograde and antegrade amnesia is the next most important sign in evaluation of patients with head injury who have lost consciousness and subsequently awakened. Whereas the duration of the amnesia is by no means itself an absolute indicator of the degree of CNS injury, it is one of the best rough clinical indicators commonly available of the severity of the head injury.