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Head Injury (Further Management (Consider: osmotherapy with…
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
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Exposure: Temp, assess for other injuries
Investigations
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Bloods: FBC, UEC, ABG/VBG
Further Management
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Avoid intracranial hypertension - maintain CPP at approx 60 (normal: 70-100, < 50 associated with cerebral ischaemia and neuronal death)
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Principles of normocapnia, normothermia, normoxia, normoglycaemia, normotension
Canadian Head CT rule
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High risk factors
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GCS < 13, 2 hours post injury
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Purpose: used to rule out serious head injury, if there are no positive high or medium risk factors consider omitting CT