Head Injuries

Question 1

Head Injury
Inital survey

Answer 1

Assess GCS, pupillary response to light, and BGL

Question 2

Head injury Adult Management

Answer 2

Head injury patients are at increased risk for vomiting and seizures.
▪ Ensure adequate oxygenation and ventilation.
▪ Administer high flow oxygen 15L NRB
▪ Ventilatory rate for adults: 10 breaths/min, for patients with no evidence of
herniation

Question 3

▪ Head injury patients with a GCS of 8 or less should be

Answer 3

INTUBATED OR ADVANCED AIRWAY

Question 4

Head injury CERVICAL Spinal Motion Restriction.

Answer 4

If patient is combative, administer KETAMINE
as per the “Chemical Restraint” Protocol AND AGGRESSIVELY MANAGE AIRWAY

Question 5

Head injury - Bleeding from scalp lacerations

Answer 5

can usually be controlled by applying a pressure
dressing or by applying direct pressure along the wound edges.
o Pressure dressings should not be applied to depressed or open skull fractures unless there is significant hemorrhage present, as this can cause an increase in ICP.

Question 6

Head Injuries
FLUID RESUSCITATION

Answer 6

Titrate fluids to maintain SBP of 110-120 should be maintained for patients with a severe head injury (GCS of 8 or less), even if the patient has associated penetrating trauma with hemorrhage.

Question 7

Signs of increased ICP and herniation include:

Answer 7

▪ A decline in the GCS of two or more points
▪ Development of a sluggish or nonreactive pupil
▪ Paralysis or weakness on one side of the body
▪ Cushing’s Triad: A widening pulse pressure (increasing systolic, decreasing
diastolic), change in respiratory pattern (irregular respirations), and bradycardia

Question 8

Treatment for Pt’s with signs of ICP and/or Herniation

Answer 8

▪ MILD HYPERVENTILATION: Maintain EtCO2 at 35 mmHg for increased ICP
▪ Consider Advanced Airway Management
▪ Head of Bed to 30 Degrees

Question 9

A single instance of hypotension in an adult with a brain injury may

Answer 9

increase the
mortality rate by 150%. The increase in mortality rate for hypotension and a
severe TBI is even worse in children.

Question 10

Infants with a bulging fontanelle are

Answer 10

considered to have a more severe head injury.

Question 11

Pediatric Head injury Management

Answer 11

▪ Head injury patients are at increased risk for vomiting and seizures.
▪ Maintain an SpO2 of 95% and EtCO2 levels between 35-45 mmHg.
▪ Head injury patients with a GCS of 8 or less should be INTUBATED OR ADVANCED AIRWAY, avoid prolonged attempts.
▪ Cervical Spinal Motion Restriction
▪ Bleeding from scalp lacerations can usually be controlled by applying a pressure dressing or by applying direct pressure along the wound edges.
o Pressure dressings should not be applied to depressed or open skull fractures unless there is significant hemorrhage present, as this can cause an increase in ICP.
▪ Provide controlled hyperventilation maintain EtCO2 at 35 mmHg for increased ICP
▪ Consider Advanced Airway Management
▪ Patients with increased ICP and/or herniation shall be transported with the head of the stretcher at a 30-degree incline.

Question 12

Pediatric Head injury
Fluid Resuscitation

Answer 12

▪ Children with severe TBI should have their SBP maintained at the normal range for their age. Administer fluid boluses of 20 ml/kg of NS and repeat prn to maintain systolic blood pressure normal for age.
▪ If patient is normotensive, administer NS
at a KVO rate.

Question 13

Pediatric Head trauma
Signs of increased ICP and herniation include:

Answer 13

o Hypertension for patient’s age
o Development of a sluggish or non-reactive pupil
o Bradycardia
o Abnormal breathing patterns
o Paralysis or weakness on one side of the body