1. INTRODUCTIONA head injury is any trauma to the scalp, skull or brain. The injury may serious or minor bump on the skull. It can be either closed or open. By definition, trauma is required to cause a head injury, but that trauma does not necessarily need to be violent. Falling down a few steps or falling into a hard object may be enough to cause damage. Motor vehicle crashes account for about 17% of traumatic brain injuries, while 35% are from falls. The majority of head injuries occur in males.In this assignment I am going to discuss about the systematic assessment of a middle aged male was lying on the ground after his motorcycle has hit the back of a car. He is bleeding profusely from an open wound on his scalp. He also appears drowsy and groaning in pain. Penetrating head injuries describe those situations in which the injury occurs due to a projectile, for example a bullet, or when an object is impaled though the skull into the brain. Closed head injuries refer to injuries in which no lacerations are present. The brain may also be injured without a direct blow to the skull. The head sits on the neck allowing it to shake, causing the brain to slosh inside the skull and become injured.Most head injuries are mild head injuries. People presenting with mild head injuries will not have any progression of their head injury. However a small percentage of mild head injuries progress to more serious injuries. Mild head injuries may be separated into low-risk and moderate-risk groups. Patients with mild-to-moderate headaches, dizziness, and nausea are considered to have low-risk injuries. Many of these patients require only minimal observation after they are assessed carefully, and many do not require radiographic evaluation. The treatment of moderate and severe head injuries begins with initial cardiopulmonary stabilization. The initial resuscitation of a patient with a head injury is of critical importance to prevent hypoxia and hypotension.

Steps for treating a head Injury Pre hospital management1. As with any injury, first assess and immediately provide care for any problems with airway, breathing, and circulation (ABC's): a. Keep the airway openb. Provide supplemental high-flow oxygen if availablec. Control any serious external bleedingd. Rescue breathing or CPR if indicatedResuscitation Basic and Advanced Trauma Life Support, and Basic and Advanced Paediatric Life Support as necessary. In severe traumatic brain injury the time from injury to definitive neurosurgical care plays a crucial role, best outcomes being in those who achieve this within four hours.[4] Other factors pertinent to all cases and especially to severe traumatic brain injury:[4] Airway - endotracheal intubation should only be performed by those experienced and with concomitant anaesthesia (risk of increasing intracranial pressure). Insertion of laryngeal mask airways is easy and provides a good seal around the oropharynx.[4] Breathing - oxygen should be provided with an aim to beginning ventilation as soon as possible. End tidal CO2 monitoring is advisable, as hyperventilation is associated with poorer outcomes, probably relating to cerebral vasoconstriction. Circulation - the systolic blood pressure should be maintained >90 mm Hg ensuring an adequate cerebral perfusion pressure - eg, boluses of 0.9% normal saline

2. Safe helmet removal requires proper instruction and practice. A helmet needs to be removed only if it: . Impedes assessment or treatment of ABC's. Prevents proper immobilization of the spine. Is loose and prevents the head from being stabilized or secured to a backboard

Conduct a rapid trauma survey and locate other significant injuries. D- Deformities C- ContusionsA-Abrasions

P- Punctures/ Penetrations

B- Burns

T- Tenderness

L- Lacerations

S- Swelling

A significant head injury is likely to have an associated spinal injury, so take spinal precautions beginning with your initial assessment. Handling Suspected Spinal Injuries. Head injury patients require a cervical collar and a backboard. Minimize movement. Full cervical spine immobilisationAttempted (unless other factors prevent this) if:[2]. GCS is