Head injuries

[Epona]

Hi. I read in my nursing book that a closed head injury is WORSE then an open head injury. It did not say WHY. Is it because you have swelling and this bad for the brain in the closed?? It would seem to me an open would be worse as the object, etc. penetrates the brain. Can you explain to me why a closed is worse??

Much thanks! Epona :hngon:

[MikeyJ, RN]

It depends on the extent of the head injury. With a severe closed injury, you usually have increasing ICP (intracranial pressures) which can damage brain tissues and cause herniation if not treated quickly enough. Severe CHI usually include intracranial hemmorhage (there are different types - subrual, subarrachnoid, epidural, etc.). Those type of CHI can be a surgical emergency.

Open head injuries can be just as severe/deadly. But it depends on the type of injury -- with OHI, you usually have a penetrating or perforating type of injury. If the object passes through the brain and hits a major blood vessel, it can be just as severe as a CHI. The skull provides great protection, thus if an object hits the head and causes and open head injury, it usually does not penetrate deep into the brain because of the skull.

I feel as if I am rambling here.. lol.. but usually a CHI as far worse results than an OHI, but an OHI (gunshot wound or something similar) can be just as severe or more severe than a CHI. Thankfully our skull protects us from objects penetrating too deeply into the brain.

[Epona]

That was good MikeyJ. I got it. Can you tell me too why when you get increased ICP, you get cerebral vasodilation?? My book says when the ICP increases, cerebral perfusion goes down and you get hypoxia, decrease in pH and increase in Co2. It says this process causes cerebral vasodilation. Do you perhaps know why?? Thanks again for trying to help!