Head injury: Nursing

Head injury describes any trauma to the structures and tissues in the head, including the scalp, skull, blood vessels; and when it causes brain damage, it’s called a traumatic brain injury, or TBI for short.

First, let’s review some anatomy and physiology. The skull has two components: the cranium and facial bones. The cranium is the bony casing that houses and protects the brain. It is lined by the meninges, which are three protective membranes that wrap around the brain and spinal cord. These three layers are the innermost pia mater, the arachnoid mater in the middle, and the outermost dura mater. Between the arachnoid and the pia mater lies the subarachnoid space, which is a thin space filled with cerebrospinal fluid that helps to cushion the brain. So within all these structures, you’d think that the brain should be pretty safe from minor trauma or injuries.

Alright now, head injuries can be caused by a variety of mechanisms, including contact head injuries, acceleration-deceleration injuries, and penetrating injuries. Contact head injuries occur when a client hits their head on a hard surface, like when falling down the stairs; or receives a violent blow or jolt to the head, such as when getting hit in boxing, or getting tackled in a football game. On the other hand, acceleration-deceleration injuries happen when the brain bounces around inside the cranium, like when a fast moving car hits a tree and stops suddenly. The bouncing of the brain inside the skull causes damage to the brain on the site of impact, called coup injury. In addition, the recoil force directs the brain the other way to strike the opposite side of the skull, resulting in another contusion called contrecoup injury. Lastly, head injuries can be caused by penetrating injuries, such as a knife or gunshot wounds.