Head Injury
Primary Survey
Breathing: RR, SpO2, oxygenation as necessary
Circulation: HR, cap refill, BP, IV access, Bloods (group and save, coags), analgesia
Airway: Intubate if GCS < 9, C-spine management
Disability: GCS/AVPU, BGL, pupils
DRS
Exposure: Temp, assess for other injuries
Investigations
+/- CTB
Bloods: FBC, UEC, ABG/VBG
Further Management
Canadian Head CT rule
Inclusion criteria
Exclusion criteria
GCS 13-15 with LOC
Confusion
Anticoagulation
Seizure
High risk factors
Amnesia
Age > 65
Signs of basilar skull fracture e.g. racoon's eyes
Open or closed depressed skull fracture
Vomiting >/= 2 episodes
GCS < 13, 2 hours post injury
Medium risk factors
Retrograde amnesia > 30 mins post event
High energy mechanism e.g. fall > 3m
Purpose: used to rule out serious head injury, if there are no positive high or medium risk factors consider omitting CT
Consider: osmotherapy with mannitol/hypertonic saline
Consider dexamethasone to decrease swelling in brain
Head up at 30degrees
Thiopentone to decrease ICP
Avoid intracranial hypertension - maintain CPP at approx 60 (normal: 70-100, < 50 associated with cerebral ischaemia and neuronal death)
Maintain ICP < 22
Aim: to prevent secondary brain injury
Principles of normocapnia, normothermia, normoxia, normoglycaemia, normotension