5-10. GENERAL MANAGEMENT OF HEAD TRAUMA

Follow these general principles in managing patients with possible head trauma:

a. Focus on maintaining adequate oxygen and cerebral blood flow.

b. Hyperventilate (increased amount of air) to decrease the increased intracranial pressure and prevent brain stem herniation by causing vasoconstriction (narrowing of blood vessels).

c. Maintain an airway. This is critical since the injured brain has increased oxygen demands.

d. Prevent coughing, bucking, seizing since any of these will raise intracranial pressure.

e. Intubate early, if possible, since a head trauma patient will frequently aspirate (intake of foreign material into the lungs during the act of breathing).

f. Protect the cervical spine.

g. Prepare to suction. Patients with head injuries often vomit.

h. Control bleeding and reestablish circulation.

NOTE: If direct pressure is used to control scalp wounds, remember to press only on a stable skull.

i. Be alert for shock. Start an IV of lactated Ringer's solution to keep a vein open and adjust the rate to the patient's needs.

j. Be observant of possible internal injury. Shock without gross bleeding will not be caused by brain injury except at the terminal stage. The patient may have internal injuries.

k. Head injury with multiple trauma should be managed the same as any other patient in shock. Establish an IV with an electrolyte solution and use a pneumatic antishock garment such as MAST, if necessary and appropriate to control bleeding.

l. A patient with only a head injury should be fluid restricted to decrease cerebral edema.

m. Anticonvulsants may be required.

n. Document carefully. Describe the patient's condition in terms of responsiveness to the environment.

NOTE: Avoid words such as lethargic, semiconscious, obtunded (to diminish pain or to diminish touch sensation).