6. Primary and immediate care of skull and brain injuries, in-hospital diagnostic examination methods

Question 1

What is to be done in a CONCIOUS head injury patient?

Answer 1

stabilize Cervical spine at all time

Circumstances surrounding injury
Period of loss of consciousness
Headache / Vomiting (common after trauma, but if persists it is a sign of raised ICP)

Calculate GCS (below 8 → intubate, ICP monitoring)

Check for skull fracture(linear, depressed, diastatic, basilar)

Focal neurological signs

Check for other injuries (chest, abdomen, limbs) (internal bleeding)
CT

Question 2

What is to be done in an UNCONCIOUS head injury patient?

Answer 2

• A → airway → intubate
• B → Breathing → hyperventilation
• C → hypotension (coloids) / hypertension (above 200 mmHg)
• D → siezures → clonazepam/phenytoin
• E → Check for other injuries (chest, abdomen, limbs) (internal bleeding) → CT

Question 3

normal ICP

Answer 3

5-10 mmhg

(goal < 20 mmhg)

Question 4

normal CPP cerebral perfusion pressure

Answer 4

60-80 mmhg ( maintain it at >60 mmhg)

Question 5

how to decrease ICP

Answer 5

1. elevate head
2. hyperventilate
3. mannitol/furosemide (avoid fluid overload)
4. hypothermia (decreases o2 demand)