PCT2 - Head

Definition: A closed head injury involves trauma to the head that does not result in external bleeding, but can lead to severe internal issues, including bleeding inside the skull.
Key Concerns: Lack of external bleeding does not eliminate potential complications associated with internal bleeding and pressure on the brain.

Description: Multi-system trauma refers to injuries affecting multiple organ systems that complicate the patient's condition, such as a head injury coupled with significant bleeding from other sources.
Example: A laceration to an artery in a limb can lead to considerable blood loss, resulting in shock, which complicates treatment for a head injury.

Cerebral Perfusion Pressure: In cases of shock, especially with significant blood loss, cerebral perfusion pressure may be reduced. This can lead to hypoxia (tissue requiring oxygen that is not being received) despite a lower pressure potentially reducing ICP (intracranial pressure).
Treatment Approach: Treatment should focus on both the shock and the head injury. For instance, rehydrating a shock patient is necessary and does not worsen the head injury even if blood pressure is low (for example, a systolic blood pressure below 90 is not inherently bad for the brain).

Definition: This rule serves as a memory aid: if a trauma patient has an oxygen saturation below 90%, a systolic blood pressure below 90, and a Glasgow Coma Scale score below 9, this indicates a dire prognosis.
Clinical Relevance: Although this rule highlights potential outcomes, it does not dictate treatment plans. Treatment must be based on individual patient assessment rather than statistical outcomes alone.

Potential Cause: A patient with a closed head injury may develop hyperpyrexia (high body temperature) due to pressure on the hypothalamus, which regulates body temperature.

Primary Actions: When managing complex cases, it is crucial to address fractures and other injuries while maintaining airway, breathing, and circulation (ABCs) priorities.
Specific Considerations:
- Monitor for cerebrospinal fluid (CSF) leaks from the nose or ears; avoid restricting CSF flow to prevent increased ICP.
- Drugs such as mannitol for cerebral edema and seizure control are typically outside the scope of paramedic practice, emphasizing the need for rapid recognition and intervention.

Non-Traumatic Brain Disorders: Conditions such as aneurysms and strokes (e.g., caused by clots or hemorrhage) can also present significant challenges in patient management.
Neoplasms: Defined as space-occupying lesions, neoplasms can cause complications due to the tight confines of the cranial cavity, leaving little room for swelling or growth.

Key Takeaway: Rapid assessment and treatment are critical in multi-system trauma situations, especially when multiple injuries coexist. Understanding the interactions and the implications of vital signs can enhance patient outcomes.