Head injury assessment

Introduction Treatment begins at the time of impact Focus on life threatening problems Less urgent problems will be addressed later

Facts 1.4 million head injuries in the us annually Leading cause of death and disability in children and young adults

Primary injury Occurs at the time of impact and is not reversible Occurs to the brain and cerebral vasculatures

Secondary injury Evolves from a cascade of cellular events Progress to initiate further injury Is a direct consequence of the primary impact

Brain oxygenation Airway obstruction and aspiration are major causes of death in patients who die of treatable head injuries Airway control is critical

Endotracheal intubation Associated with risks of increased ICP, aspiration and hypoxia The detrimental effects may not be reversible Positive pressure ventilations can increase intrathoracic pressure and decrease venous return May delay transport

Supplemental o2 All head injury patient should receive supplemental O2 Maintain saturations greater than 90% If GCS is less than 8 intubation is unavoidable

Hypotension There is a significant association between hypotension and poor outcomes Administer IV fluids to avoid hypotension or minimize the duration

Suspected increased icp Perform serial GCS evaluations A drop of 2 or more points is considered significant

temperature Hypothermia is a predictor of death in trauma patients Keep your patient warm

transport Odds of survival (1.6 to 2.25) are better with air transport Level I or regional trauma centers should be the destination of choice

conclusion The goals of managing a head injury are to stabilize and transport

For more information: http://www.medscape.com/viewarticle/585165_5