4.2 Head Injury Flashcards
(6 cards)
List criteria for I+V in patient w/ Head Injury
Ensure C-Spine remains immobilized during MV and Instrumentation
Immediately:
1) GCS <8
2) Unable to protect airway
- laryngeal reflex / high risk aspiration
3) Ventilatory insufficiency despite HFO2
PaO2<13 / PaCO2 >6
4) Spontaneous hyperventilation
PaCO2 < 4
I+V prior to transfer
- Significant deterioration GCS even if >8
- Evidence unstable facial #
- Excess bleeding in mouth
- Seizures
Transfer prep
Clear and detailed comm w/ Neurosurgeon + Centre
Assess and resus
often need to prioritise rapid transfer for intervention
1)
Airway - ETT guideline as above
2) Breathing
Adequate sedation / analgesia / muscle relaxation
Aim PaO2 >13
Paco2 4.5 - 5kPa
Hypervent w/ high Fio2 if rad or clin evidence of rising ICP
Ensure inspired gases HME filtered
CVS
Obrain wide bore access
take blood including x match
Arterial cannula
invasive BP monitoring
ABG sampling
Maintain map > 80mmHg
Fluids +/- vasopressors
Time obtain CVC
fem or subclavian ideally
Catheterise
Retention can rise ICP
D
Avoid obstruction of venous drain
- nurse 30’ head up
secure ETT w/ Tape
Regular assessment of pupil size and reactivity
Everything else
Insert NG allow free drain
Check BGL
?insulin infusion
persist high - infusion
Trained and experience assistant for transfer
Transfer bag stocked
phone communication
batteries pumps
Copy of rad ix for receiving unit
Clear notes
standard tfer documentation
Communication w/ surgeons
- update clin situation
Neuro changes
