Management of Head Injury This publication is designed to offer information suitable for use by an appropriately trained physician. The information p

Airway management in head injury

Intubate if airway/ventilation is inadequate, patient is unresponsive, or requiring sedation.

PCO2 maintenance

Maintain PCO2 > 35 mmHg at normal levels during breathing management.

Systolic blood pressure target

Keep systolic blood pressure > 90 mmHg to prevent worsening head injury.

Glasgow Coma Scale (GCS)

A scale to assess neurological status, ranging from 3 (deep coma) to 15 (fully alert).

Key components of GCS

Best Eye Opening, Best Verbal Response, Best Motor Response.

Intracranial mass lesion suspicion

Asymmetrical motor responses increase suspicion of an intracranial mass.

Indications for CT scan of head

Obtain if patient is comatose, GCS ≤ 13, or has lateralizing neuro-examination findings.

Signs of herniation

Sudden deterioration in consciousness, dilating pupil, and decreased motor response.

Mannitol use in head injury

Administer Mannitol 1 g/kg IV push (if BP stable) after neurosurgical consultation.

C-spine x-ray necessity

Obtain lateral C-spine x-ray as spine fractures are present in 5%-20% of severe head injury cases.

Risk with spine injury

Assume a spine injury until ruled out; use orogastric tube if skull/midface fracture is suspected.

Potential effects of low BP

Systolic BP < 90 mmHg can lead to secondary brain injury.

Assessing neurologic abnormalities

Do not solely attribute neurologic abnormalities to drugs/alcohol; conduct thorough assessments.

Initial management for head injury

Assess and secure airway, breathing, and circulation before advanced interventions.

Secondary brain injury prevention

Aim to prevent hypoxia, hypotension, and hypercapnia to reduce secondary injury risk.

Significance of pupils in head injury

Pupil size and reactivity can indicate the presence of brain injury or increased intracranial pressure.

Importance of early intubation

Early intubation can prevent airway compromise, especially in decreasing GCS patients.

Cushings Triad

Hypertension, bradycardia, and irregular respirations indicating increased intracranial pressure.

Indications for neurosurgical intervention

Consider intervention if intracranial pressure is persistently elevated or mass effect is present.

Signs of skull fracture

Look for raccoon eyes, battle sign, and clear fluid drainage from nose or ears.

Role of neuroprotective strategies

Include maintaining normothermia and controlling blood glucose levels post-head injury.

Assessment of motor function

Assess for motor weakness or paralysis as part of neurological examination.

GCS and intubation decision

Consider intubating if GCS is ≤ 8 due to inadequate protective airway reflexes.

Initial vital sign assessment

Perform a rapid assessment of vital signs to identify stability in head injury patients.

Signs of increasing intracranial pressure

Monitor for headache, vomiting, and changes in consciousness as signs of increased intracranial pressure.

Neuro checks frequency

Conduct neurological checks every 15 minutes for the first hour in significant head injuries.

Role of hyperventilation

Hyperventilation may be used temporarily to lower intracranial pressure but should be limited.

Fluid resuscitation parameters

Use IV fluids judiciously, maintaining euvolemia while avoiding hypotonic solutions.

Posturing Types

Decerebrate and decorticate posturing may indicate different levels of brain dysfunction.

Medication contraindications

Avoid anticoagulants and antiplatelet agents in acute head injury management unless indicated.

Secondary Injury Mechanisms

Identify mechanisms such as hypoxemia and hypotension that contribute to secondary brain injury.