Description

Management of head injuries 1. Extensive scalp laceration- . The bleeding is controlled by suturing the scalp. . The skull is trephined and blood clot is removed and the bleed 2. Penetrating injury and depressed fracture of the skull- The penetrating foreign body is removed and the depressed fracture is brought to its correct alignment. 3. Extradural Haematoma- This is usually caused by a skull fracture injuring an underlying artery of the dura mater. This life-threatening condition needs ultra-urgent surgical intervention. The results of such treatment are very gratifying if performed in time. The patient who otherwise would have lost their life gains consciousness within hours and recovers. 4. Brain contusion and Acute Subdural Haematoma- Severe injuries to the brain lead to contusion and laceration of the brain and sometimes rupture of bridging veins on the surface of the brain. This results in the accumulation of blood clots on the surface of the brain under the dura mater. The brain becomes tense leading to an increase in intracranial pressure and rapid deterioration in consciousness and often come. The patients have to be supported by a ventilator and treatment started with Mannitol, glycerol, etc. to reduce intracranial pressure. Such patients usually run a risk of brain stem compression due to herniation (shifting) of the brain. Immediate surgical intervention is needed by doing a large decompressive craniectomy. In this surgery, a large portion of the skull is lifted off and the dura mater is widely opened to allow the swollen brain to bulge outwards thus relieving the compressive effect from the brain stem. Results of this surgery are also gratifying provided the procedure is completed in time before any irreversible damage to the brain stem could take place.

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