Adult Head Injury

Question 1

Adult Head Injury - Initial actions

Answer 1

Consider SMR
O2
BGL
Consider elevating head 30 degrees
Maintian ETCO2 30-50 mmHg

Question 2

Adult Head Injury - Airway management required?

Answer 2

Refer to Basic and Advanced airway algorithms

Question 3

Adult Head Injury - Prophetically treat?

Answer 3

Vomiting - Zofran 4mg IV

Question 4

Adult Head Injury - Hypoglycemic?

Answer 4

12.5 g D50W repeat if BGL remains below 4

Question 5

Adult Head Injury - MAP <80 or Systolic <110 tx?

Answer 5

20 ml/kg bolus x 2

Mandatory OLMC for refractory hypotension for either more fluid or Norepinephrine

Question 6

Adult Head Injury - Cerebral herniation syndrome tx?

Answer 6

Mandatory OLMC

Hyperventilate to ETCO2 of no less than 30 mmHg for 30 min then maintain ETCO of 30-35 mmHg

Question 7

Adult Head Injury - MAP >110 or systolic > 160 tx?

Answer 7

Mandatory OLMC

Question 8

Adult Head Injury - Elevate the head 30 degrees if?

Answer 8

MAP >80 mmHg or Systolic BP >110 mmHg

Question 9

Adult Head Injury - Signs of Cerebral Herniation Syndrome?

Answer 9

Decreasing LOC progressing to coma
Pupils unequal and/or not reacting
Pupils deviated down and to side opposite the injury
Respirations may contain deep sighs, yawns and occasional pauses that progress to Cheyne-Stokes
Decerebrate or decorticate posturing

Question 10

Adult Head Injury - MAP calculation?

Answer 10

(Diastolic x 2) + Systolic / 3

Question 11

Adult Head Injury - ondansetron indication?

Answer 11

Nausea and vomiting associated with head injury

Question 12

Adult Head Injury - ondansetron dose?

Answer 12

Prophylactic

ondansetron 4 mg SIVP or 8 mg IM

Question 13

Adult Head Injury - ondansetron contraindications?

Answer 13

Hypersensitivity

Question 14

Adult Head Injury - D50W indications?

Answer 14

Head injury with symptomatic hypoglycemia

Question 15

Adult Head Injury - D50W dose?

Answer 15

12.5 g SIVP/IO

repeat 12.5 g D50W if BGL remains <4.0 mmol/L

Question 16

Adult Head Injury - D50W contraindications?

Answer 16

Allergy to corn or corn products

Question 17

Adult Head Injury - D50W precautions?

Answer 17

Ensure patency of IV site after half of dose is administered

Question 18

Adult Head Injury - norepinephrine indications?

Answer 18

Head Injury with hypotension refractory to fluid resuscitation

Question 19

Adult Head Injury - norepinephrine dose?

Answer 19

Mandatory OLMC
0.1 mcg/kg/min to 0.3 mcg/kg/min
Titrate to effect, increasing dose as per infusion chart q 3 minutes

Question 20

Adult Head Injury - norepinephrine contraindications?

Answer 20

Mesenteric or peripheral vascular thrombosis
Pregnancy
Profound hypoxia
Hypovolemia

Question 21

Adult Head Injury - norepinephrine precautions?

Answer 21

MAOI or TCO use

Question 22

Adult Head Injury - Norepinephrine Preparation?

Answer 22

Add 4 mg to 246ml NS or D5W = 16 mcg/ml

Question 23

Adult Head Injury - Norepinephrine if extravasation occurs?

Answer 23

Stop infusion

Notify the receiving facility for phentolamine