Trauma (Traumatic head injury)

Question 1

when assessing pattern of injury, the patient can be considered to have a serious blunt head injury with or without loss of consciousness/amnesia and GCS 13-15 with any of what?

Answer 1

• any loss of consciousness exceeding 5 minutes
• skull fracture (depressed, open or base of skull)
• vomiting more than once
• neurological deficit
  
  • seizure

Question 2

Recite the Traumatic head injury CPG

Answer 2

Question 3

What is 5HEDS?

Answer 3

• (5) any LOC exceeding 5 mins
• (H) Head injury → skull # (depressed, open or BOS)
• (E) Emesis → vomiting more than once
• (D) neurological Deficit
• (S) Seizure

Question 4

What is a primary head injury?

Answer 4

• initial insult
• coup/contre-coup injuries

Question 5

What is a secondary head injury?

Answer 5

• delayed (minutes to days)
• oedema/vasodilation/increased ICP
• Decreased Na+/K+ pump

Question 6

What are some bad signs of a traumatic HI?

Answer 6

• Widening pulse pressure e.g. 220/40
• Bradycardia
• decreased respirations

Question 7

What sats, ETCO2, CPP and position should you aim for in patients with a HI to prevent a secondary HI?

Answer 7

• sats >94%
• ETCO2 35-45
• CPP >120 mmHg
• HOB 30 degree (has potential to improve cerebral blood flow by improving venous drainage)

Question 8

Can you insert an OP/NP in a patient with a HI?

Answer 8

• No

Question 9

Can you give midazolam to a combative patient with a HI?

Answer 9

• No - they need analgesia