Nursing the head trauma patient

Head trauma is commonly seen in veterinary emergency clinics. Animals sustain head trauma in numerous ways, including road traffic accidents, falling from heights, kicks from horses, being stepped on by owners (Figure 1). Animals with head trauma require immediate medical attention. The patient may also have concurrent injuries, such as circulatory or respiratory problems, which need to be addressed during the initial treatment and stabilisation period.

There are two types of head trauma or brain injury: primary and secondary. Primary head trauma, such as a skull fracture or cerebral haemorrhage, describes the injury to the brain tissue from direct trauma and the forces applied to the brain at impact, these forces include acceleration, deceleration and rotational forces (Freeman and Platt, 2012). The brain is unable to tolerate these forces because of its composition and lack of internal support. Secondary head trauma occurs following the primary trauma; following impact, a cascade of biomolecular events occur causing continued and progressive brain pathology. The presence of haematomas and oedema from the primary injury distorts normal brain parenchyma and decreases cerebral blood flow. In addition, a series of cellular reactions occur at the time of impact, and continue after the injury (Freeman and Platt, 2012). An important goal of treating head trauma is to limit or prevent secondary trauma.