Traumatic Head Injury

Question 1

What are the 2 care objectives in traumatic head injury?

Answer 1

1. To identify and appropriately triage potentially serious head injury.
2. To optimize ventilation, oxygenation and cerebral perfusion pressure to prevent secondary brain injury.

Question 2

When assessing a pattern of injury, a pt can be considered to have a serious blunt head injury if…?

Answer 2

With or without LOC/amnesia, at GCS 13-15 with any of:

1. Any LOC >5mins
2. Skull fracture (depressed, open, base of skull)
3. > 1 emesis
4. neurological deficit
5. seizure

Question 3

What note is made about elderly patients with standing height falls who meet no other time critical criteria?

Answer 3

If on antiplatelet or anticoagulant therapy, or have bleeding disorders, should not be underestimated. Tx to an appropriate level of care.

Question 4

Who is at high risk of occult clinically significant head injury?

Answer 4

Intoxicated pts with apparently minor MOIs.

Question 5

How are extremely agitated traumatic head patients managed?

Answer 5

Ketamine as per Agitation.

Question 6

If ?spinal injuries and pt being intubated, when should the collar be applied and what considerations should be made?

Answer 6

Post-intubation, attempt to minimise jugular vein compression.

Question 7

What Mx should be taken if adequate blood pressure can not be achieved or other signs of unacceptably poor perfusion?

Answer 7

Consult for further fluid or vasopressors.

Question 8

What three ASSESS points should be considered in the head injured patient?

Answer 8

Time critical head injury
Other head injury
Pupillary response

Question 9

What are the 4 key management points for the head injured patient?

Answer 9

1. Airway
2. Ventilation
3. Perfusion
4. General care

Question 10

What airway management pathways may be required under the Traumatic Head Injury guideline?

Answer 10

If airway patent, do not insert NPA/OPA.
If airway not patent, consider:
- Airway position + mask seal if ventilating
- Suction if required
- NPA

If GCS <10, intubate. If intubation not possible/authorized, and gag absent insert SGA.

Question 11

What ventilation targets are required under the Traumatic Head Injury guideline?

Answer 11

Ensure adequate ventilation, oxygenation:
Vt 6-7ml/kg
SPO2 >95%
EtCO2 30-35mmHg

Rx causes of hypoxia and avoid hypo/hypercapnia

Question 12

What is the perfusion management under the Traumatic Head Injury guideline?
What blood pressures govern the management in this section?

Answer 12

Aiming for an SBP of >120mmHg
- Normal Saline IV max. 40mL/kg
(unless penetrating truncal trauma, or uncontrolled overt bleeding)
If SBP <100mmHg after 40mL/kg consult for further fluids. If no consult available, Normal Saline 20mL/kg IV.

Question 13

What other general care is referenced under the Traumatic Head Injury guideline?

Answer 13

Rx sustained seizures
Rx hypoglycaemia
Tx as per time critical guidelines
Analgesia as required