Traumatic brain injury first aid

Classification and symptoms of TBI

Head injuries are divided into two major groups depending on the integrity of the epicranial aponeurosis (galea aponeurotica).

• Closed TBI: the aponeurosis remains intact, so the internal environment of the skull is hermetic. Bone fractures or damage to the skin and soft tissues may still be present.
• Open TBI: the aponeurosis is ruptured, providing direct communication with the external environment. It can be non-penetrating (dura mater unaffected) or penetrating (dura mater damaged).

The clinical presentation includes headache, dizziness, nausea and vomiting, general weakness, and drowsiness. Loss of injury awareness or consciousness frequently occurs. A specific sign is amnesia — the victim forgets both the moment of injury and the events that preceded it.

First aid algorithm

Actions at the scene must be prompt and decisive:

1. If the patient is conscious, lay them supine. Be sure to monitor pulse and breathing.
2. If consciousness is absent, place the victim in the recovery position on their side. This is vital to prevent airway obstruction by the tongue and the entry of vomitus into the respiratory tract (aspiration).
3. If a wound is present, apply a dressing to it.
4. If the injury is open, absolutely do not apply direct pressure onto the wound itself. First, carefully surround its edges with bandages, and only then apply a fixing bandage over it.

Associated facial injuries and multidisciplinary approach

If brain damage is accompanied by maxillofacial trauma, treatment tactics become more complex. The primary goal is to restore brain and facial tissue functions while avoiding complications. Emergency care must be provided as quickly and thoroughly as possible, adhering to the principles of atraumatism and aesthetics.

The treatment plan is always drawn up by a maxillofacial surgeon, but consultation with a neurosurgeon is mandatory. Neurosurgical operations frequently take priority as they are aimed at saving life. If necessary, an ophthalmologist, otolaryngologist, and orthopedic trauma surgeon are involved in the treatment.

When planning treatment, surgeons determine three key parameters: timing of care, scope of intervention, and method of bone fragment fixation. If there are no indications for surgery, conservative therapy is prescribed in accordance with clinical guidelines ("Focal Brain Injury", "Traumatic Brain Injury in Children").

Diagnostic imaging in the acute period

Computed tomography (CT) serves as the first-line method for detecting primary injuries (hemorrhages, hematomas, depressed fractures, hydrocephalus, brain shift).

The scan is performed without intravenous contrast, with the patient lying supine. A topogram is first acquired to plan the scan and search for vault fractures or foreign bodies. Then, a spiral scan is performed from the skull base to the vertex with a slice thickness of 0.75–1 mm, providing high spatial resolution and enabling multiplanar reconstructions.

For precise image evaluation, physicians use different window settings:

• Narrow tissue window (e.g., 40 HU / 80 HU): for studying the brain parenchyma on slices up to 5 mm.
• Wide window (e.g., 70 HU / 150–200 HU): for detecting acute hemorrhages. It enhances the contrast between blood and bone, revealing small hematomas.
• Bone algorithm: for detailed evaluation of bone structures and 3D reconstruction of fractures (especially non-displaced linear fractures).

It is important to remember the limitations: bone artifacts frequently occur at the boundary between the brain and the skull base, requiring careful analysis of thin slices. To search for hemorrhages in the region of the falx cerebri (falx cerebri) and tentorium cerebelli (tentorium cerebelli), as well as to assess brain herniation, the coronal plane is invariably used. The sagittal plane is optimal for examining the clivus (clivus) and craniovertebral junction.

Class and exam questions

What else to study on this topic

• Evaluation of secondary injuries on CT: edema, ischemia, delayed hemorrhage
• Anatomy of structures on sagittal CT slices: clivus, pituitary fossa
• Methods of bone fragment fixation in associated facial injuries
• Features of conservative treatment for focal brain injury
• Three-dimensional surface reconstruction of cranial bones

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.