Head Injuries
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Head Injuries as PDF for free.
More details
- Words: 378
- Pages: 3
Head Injuries If in Doubt, Seek Neurological Advice
HISTORY • • • • • •
Mode and Time of injury. Initial GCS. Duration of loss of consciousness. Any obvious neurological signs at the time. Trend in GCS since then. Background illnesses and medications or drugs, especially alcohol
EXAMINATION • • •
•
Assess Glasgow Coma Score. Assess limb strength for asymmetry Assess pupillary size, asymmetry or lack of pupillary reaction. Injury to the scalp, skull, neck, face including cuts, abrasions or bruising and including CSF leakage from ear or nose.
PROTOCOLS FOR THE MANAGEMENT OF HEAD INJURIES This protocol is designed for use with the general protocol for management of trauma patients (and presumes that it has been followed in relation to airway and haemodynamic management). It presumes a brisk clinical examination and appropriate history. If operation is required for other reasons, head injury management may become more difficult. Consult the duty neurosurgeon.
A. GCS 8 OR LESS : Action: Call Neurosurgeon. • • • • •
Sedate, paralyse and intubate patient Ventilate (PCO2 about 30 mm Hg) Mannitol 20% lg/kg IVI stat Emergency CT scan as soon as possible. Peritoneal lavage all patients in this category.
B. GCS 9 -14 WITH FOCAL SIGNS : Action: Call Neurosurgeon. • • •
Half hourly neuro observations. If decreased GCS go to A above. Urgent CT scan within 2 hours.
C. GCS 9 -14 WITHOUT FOCAL SIGNS BUT FRACTURE ON SKULL X-RAY : Action: • • •
•
Half hourly neuro observation for 6 hours. If decreased GCS develops, or focal signs, go to A above. If GCS stable at 6 hours, hourly observation for 12 hours, then 4th hourly for 8 hours. At 24 hours if GCS 15 and if home environment supervised, discharge with head injury card.
D. GCS 9 -14 WITHOUT FOCAL SIGNS, NO FRACTURE ON SKULL X-RAY : Action: •
•
Half hourly neuro observation for 6 hours If decreased GCS develops, or develops focal signs, go to A above. If GCS 15 at 6 hours and home environment supervised, discharge with head injury card.
E. GCS 15 ON ARRIVAL, NO FOCAL NEUROLOGICAL SIGNS AND NO SKULL FRACTURE ON X-RAY : Action: •
Observe half hourly for 4 hours and discharge home with
head injury card.
HISTORY • • • • • •
Mode and Time of injury. Initial GCS. Duration of loss of consciousness. Any obvious neurological signs at the time. Trend in GCS since then. Background illnesses and medications or drugs, especially alcohol
EXAMINATION • • •
•
Assess Glasgow Coma Score. Assess limb strength for asymmetry Assess pupillary size, asymmetry or lack of pupillary reaction. Injury to the scalp, skull, neck, face including cuts, abrasions or bruising and including CSF leakage from ear or nose.
PROTOCOLS FOR THE MANAGEMENT OF HEAD INJURIES This protocol is designed for use with the general protocol for management of trauma patients (and presumes that it has been followed in relation to airway and haemodynamic management). It presumes a brisk clinical examination and appropriate history. If operation is required for other reasons, head injury management may become more difficult. Consult the duty neurosurgeon.
A. GCS 8 OR LESS : Action: Call Neurosurgeon. • • • • •
Sedate, paralyse and intubate patient Ventilate (PCO2 about 30 mm Hg) Mannitol 20% lg/kg IVI stat Emergency CT scan as soon as possible. Peritoneal lavage all patients in this category.
B. GCS 9 -14 WITH FOCAL SIGNS : Action: Call Neurosurgeon. • • •
Half hourly neuro observations. If decreased GCS go to A above. Urgent CT scan within 2 hours.
C. GCS 9 -14 WITHOUT FOCAL SIGNS BUT FRACTURE ON SKULL X-RAY : Action: • • •
•
Half hourly neuro observation for 6 hours. If decreased GCS develops, or focal signs, go to A above. If GCS stable at 6 hours, hourly observation for 12 hours, then 4th hourly for 8 hours. At 24 hours if GCS 15 and if home environment supervised, discharge with head injury card.
D. GCS 9 -14 WITHOUT FOCAL SIGNS, NO FRACTURE ON SKULL X-RAY : Action: •
•
Half hourly neuro observation for 6 hours If decreased GCS develops, or develops focal signs, go to A above. If GCS 15 at 6 hours and home environment supervised, discharge with head injury card.
E. GCS 15 ON ARRIVAL, NO FOCAL NEUROLOGICAL SIGNS AND NO SKULL FRACTURE ON X-RAY : Action: •
Observe half hourly for 4 hours and discharge home with
head injury card.
Related Documents
Head Injuries
June 2020 8
Head Injuries
June 2020 12
Head Injuries
April 2020 15
Head Injuries
November 2019 23
Closed Head Injuries
December 2019 9