Aliases
None noted
Patient Care Goals
- Limit disability and mortality from head injury by:
- Promoting adequate oxygenation
- Promoting adequate cerebral perfusion
- Limiting development of increased intracranial pressure
- Limiting secondary brain injury
Patient Presentation
Inclusion Criteria
Adult or pediatric patient with blunt or penetrating head injury – LOC or amnesia not required
Exclusion Criteria
No recommendations
Patient Management
Assessment
- Maintain cervical stabilization [see Spinal Care guideline]
- Primary survey per the General Trauma Management guideline
- Monitoring:
- Continuous pulse oximetry
- Frequent systolic and diastolic blood pressure measurement
- Initial neurologic status assessment [see Appendix VII – Neurologic Status Assessment] and reassessment with any change in mentation
- Moderate/severe head injury – apply continuous waveform ETCO2, if available
- Secondary survey pertinent to isolated head injury:
- Head – Gently palpate skull to evaluate for depressed or open skull fracture
- Eyes:
- Evaluate pupil size and reaction to light to establish baseline
- Reassess pupils if decrease in mentation
- Nose/mouth/ears – evaluate for blood/fluid drainage
- Face – evaluate for bony stability
- Neck – palpate for cervical spine tenderness or deformity
- Neurologic:
- Perform neurologic status assessment (GCS or AVPU)
- Evaluate for focal neurologic deficit: motor and sensory
Treatment and Interventions
NOTE: These are not necessarily the order they are to be done, but are grouped by conceptual areas
- Airway:
- Administer oxygen as appropriate with a target of achieving 94-98% saturation
- If patient unable to maintain airway, consider oral airway (nasal airway should not be used with significant facial injury or possible basilar skull fracture)
- Advanced airways can be used if BVM ventilation ineffective in maintaining oxygenation or if airway is continually compromised
- Nasal intubation should not be used in patients with head injury
- Breathing:
- For patients with a moderate or/severe head injury who are unable to maintain their airway: use continuous waveform capnography, and EtCO2 measurement if available, with a target EtCO2 of 35-40 mmHg
- Extraglottic airway placement or/endotracheal intubation should only be performed if BVM ventilation is inadequate to maintain adequate oxygenation with a target EtCO2 of 35-40 mmHg
- For patients with a severe head injury with signs of herniation: hyperventilate to a target EtCO2 of 30-35 mmHg as a short-term option, and only for severe head injury with signs of herniation
- Circulation:
- Wound care
- Control bleeding with direct pressure if no suspected open skull injury
- Moist sterile dressing to any potential open skull wound
- Cover an injured eye with moist saline dressing and place cup over it
- Moderate/severe closed head injury
- Blood pressure: avoid hypotension
- Adult (age greater than 10 yo): maintain SBP greater than or equal to 110 mmHg
- Pediatric: maintain SBP:
- less than 1 month: greater than 60 mmHg
- 1-12 months: greater than 70 mmHg
- 1-10 yo: greater than 70 + 2x age in years
- Blood pressure: avoid hypotension
- Closed head injury
- Consider administering NS fluid bolus to maintain blood pressure to above numbers and maintain cerebral perfusion
- Do not delay transport to initiate IV access
- Wound care
- Disability:
- Evaluate for other causes of altered mental status – check blood glucose
- Spinal assessment and management, per Spinal Care guideline
- Perform and trend neurologic status assessment (moderate/severe: GCS 3-13, P {pain} or U {unresponsive} on AVPU scale)
- Early signs of deterioration:
- Confusion
- Agitation
- Drowsiness
- Vomiting
- Severe headache
- Monitor for signs of herniation
- Early signs of deterioration:
- Severe head injury – Elevate head of bed 30 degrees
- Transport destination specific to head trauma
- Preferential transport to highest level of care within trauma system:
- GCS 3-13, P (pain) or U (unresponsive) on AVPU scale
- Penetrating head trauma
- Open or depressed skull fracture
- Preferential transport to highest level of care within trauma system: