Traumatic Head Injury (Adult) |
| Status |
| Severe traumatic head injury |
|
|
|
|
|||||||||
| Airway | ||||||||||||
| If airway patent and Tidal Volume adequate (with trismus), do not insert NPA | ||||||||||||
| If airway not patent and gag is present, insert NPA and ventilate | ||||||||||||
| If GCS <10, regardless of airway reflexes, intubate as per Intubation: RSI | ||||||||||||
| If intubation is not possible/authorised and gag is absent insert LMA | ||||||||||||
| Ventilation | ||||||||||||
| Ensure adequate ventilation and Tidal Volume of 10ml/kg | ||||||||||||
| Maintain SpO2 >95% and treat causes of hypoxia | ||||||||||||
| Maintain EtCO2
at 30-35mmHg Avoid hypo/hypercapnia |
||||||||||||
| Perfusion | ||||||||||||
| Manage with Normal Saline as per Hypovolaemia (unless in the setting of penetrating truncal trauma or uncontrolled overt bleeding | ||||||||||||
| Aim for systolic BP >120 | ||||||||||||
| After 40ml/kg reassess. If systolic BP <100, discuss ongoing resuscitation with the receiving Regional or Major Trauma Service while continuing to transport | ||||||||||||
| If consult is unavailable administer a further Normal Saline 20ml/kg IV and reassess | ||||||||||||
| General Care | ||||||||||||
| Treat sustained seizure activity with Midazolam as per Continuous Tonic–Clonic Seizures | ||||||||||||
| Measure BGL and rectify hypoglycaemia | ||||||||||||
| Triage to highest level of care as per Trauma Time Critical Guidelines | ||||||||||||
If patient does not meet Trauma Time Critical Guidelines criteria, Triage patient to next highest or appropriate level of trauma care |
||||||||||||
| Special Notes |
| The Trauma Time Critical Guidelines require patients with Significant Blunt Trauma to a Single region to be triaged to the highest level of car |
| A Significant Blunt Trauma Head Injury can be described as the following: Blunt Head Trauma with or without Loss of Consciousness/Amnesia and GCS 13-15 with any of: • Any Loss of Consciousness exceeding 5 Minute • Skull Fracture (Depressed, Open or Base of Skull) • Vomiting more than once • Patient on Anti-Coagulants or with Bleeding Disorders • Neurological Deficit • Seizure |
| General Care |
| Dress open skull fractures/wounds with sterile combine soaked in sterile Normal Saline |
| Maintain manual in-line neck stabilisation and apply cervical collar when convenient. If intubation is required, apply cervical collar after intubation. Attempt to minimise jugular vein compression. |
| Attempt to maintain normal temp. |