Traumatic head injury CPG

Question 1

Care objective

Answer 1

• To asses and triage a potentially serious head injury

- To optimize ventrilation, oxygenation and maintain cerebral pressure to prevent secondary brain injury

Question 2

When should a patient be considered to have a serious blunt force head injury

Answer 2

With or without loss of consciousness/ amnesia with a GCS 13-15 and one:

• Loss of consciousness exceeding 5 minutes
• Skull fracture (depressed, open or base of skull)
• Vomiting more than once
• Any neurological defect
• Seizure

Question 3

If an elderly patient has a fall from standing hight what should be considered?

Answer 3

If they are on anti-platelet or coagulant agents or have bleeding disorders these shouldn’t be underestimated and they should be transported to the nearest level of care

Question 4

If a patient is combative what should be done?

Answer 4

No use of midazolam prior to RSI, judicious opioids should be given for pain management. If the patients remains combative a small ketamine bolos may be given.

Question 5

If a patient is severely aggressive what should be done?

Answer 5

They should be managed under the agitation guideline

Question 6

What do you do with open wounds or skull fractures?

Answer 6

Cover with the appropriate dressing

Question 7

If you cannot achieve adequate blood pressure what should be done?

Answer 7

Consult for further management or fluids and consider the use of pressers (MICA)

Question 8

What are the four sections under the action?

Answer 8

• Airway
• Ventilation
• Perfusion
• General care

Question 9

What is done for the airway?

Answer 9

Patent - do not insert OPA or NPA
Not Patent- Positing and mask seal, suctioning, insert a NPA
No gag reflex- SGA

Question 10

What is done for ventilation?

Answer 10

Ensure adequate ventilation and oxygenation

6-7ml/kg of airflow
SPO2 above 95%
ETCO2 30-35 mmHg

Manage causes of hypoxia and hypercapnia

Question 11

What is done for perfusion?

Answer 11

Normal saline max 40ml/kg
- triturate to patient response (unless uncontrolled overt bleeding or penetrating facial trauma) aim for BP >120

If patient remain with BP <100
Consult for further fluids, if unavailable max 20mg/kg more

Question 12

What is done for general care?

Answer 12

• Seizure CPG
• Hypoglycaemia CPG
• Pain relief CPG
• Time critical guidleines