Head Injury (Adult) Flashcards
(25 cards)
Recite the head injury CPG (Part 1)
High and moderate risk
What are the care objectives for Head injury?
Moderate-Severe TBI:
* Optimise airway patency, oxygenation, ventilation and cerebral perfusion pressure to prevent secondary brain injury
Mild TBI/other head injuries:
* Identify high risk patients and triage to neurosurgical facility where possible
* Identify moderate risk patients and transport to ED for CT or observation
* Identify low risk patients and refer into the community with self-care advice
Recite the head injury CPG (part 2)
Low risk
What MAP should you maintain to achieve a normal CPP and ICP
MAP 90
What are the indications for NaCl
What are the contraindications for NaCl?
What are the precautions for NaCl
What are the side effects of NaCl
Why do we use NaCl in the head injured patient?
- To maintain CPP
- To avoid secondary brain injury
Does O2 therapy guideline apply to this presentation?
- YES
- Critical illness = major trauma/head injury
Does the trauma triage guideline apply to this presentation?
- Yes
- Potential
- Penetrating trauma
- Blunt trauma
OR - MBA/cyclist impact > 30km/hr
- Highspeed MVA > 60km/hr
- Pedestrian impact
- Ejection from vehicle
- Fall from height > 3m
- Struck on head by falling object > 3m
+ - Age >55
- Pregnant
- Significant underlying medical condition
Are there any relevant CWI’s
- Airway management
- Breathing” ventilation/oxygenation
- IV insertion
- Preparing medications for administration
What are 3 differential diagnoses for Head injury?
- Traumatic head injury
- C spine #
- SAH
What are some care pathways/treatment options for Head injury?
- Reassurance
- Airway
- Breathing
- Circulation
- Supportive care
- IV access
- Na Cl ?
- Pain relief
- Nausea/vomiting
- High risk → Transport as per trauma triage
- Moderate risk → Transport/consider VVED
- Low risk → self care, safety netting, provide health information sheet, GP f/u 2-3/7
- Reassessment
Are there any extrication considerations in the head injured patient?
- Consider C spine precautions
- HOB 15 degrees
As per OPA CWI, why is TBI/nTBI with adequate ventilation/oxygenation listed as a contraindication
Knowledge question
- It stimulated the gag reflex in this group and can significantly worsen ICP
As per NPA CWI, why are facial fractures and suspected BOS # listed as a precaution
Knowledge question
- Possibility of cerebral intrusion, only insert if absolutely necessary to maintain patients aiway
Are there any relevant secondary surveys?
- Nexus
- Full neurological examination
- AEIOUTIPS
- DOLAR
What are the indications for IV insertion
What are the contraindications for IV insertion
What are the precautions for IV insertion
What are the indications for preparing medications for administration
What are the contraindications for preparing medications for administration
What are the precautions for preparing medications for administration
