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Absent.
Reduce disability and mortality from head injuries by:
Adults or children with blunt or penetrating head trauma – presence of altered consciousness or amnesia is not an inclusion criterion.
Absent.
1. Fixation of the cervical spine (see the instruction “Help with spine injury”).
2. Initial examination according to the guideline “General trauma”.
3. Monitoring:
a) continuous pulse oximetry;
b) periodically check BP;
c) initial assessment of neurological status (see Appendix 3) and re-assessment at any what change in thinking;
d) moderate/severe head injury – use continuous ETCO2 waveform if available.
4. Secondary examination (based on the presence of an isolated head injury):
a) head – gently palpate the skull to identify closed/open skull fractures;
b) eyes:
c) nose/mouth/ears – assess the presence of blood/fluid drainage;
d) face – assess the stability of the bones of the facial skull;
e) neck – perform a palpation to detect sensitivity or spinal deformity;
e) neurological examination:
Attention: below is a list that is formed according to the principle of conceptual unification, so the course of interventions may change.
1. Respiratory tract:
a) provide oxygen therapy, the target level of oxygenation is 94-98%;
b) if the patient is unable to independently maintain the patency of the airways, use an oral airway (the nasal airway does not have be used in the presence of extensive facial trauma or a possible fracture of the bones of the base of the skull);
c) oral endotracheal intubation or the introduction of pressure devices can be used if ventilation with an AMBU bag is not an effective means of maintaining oxygenation or if there are permanent obstructions to the patency of the respiratory tract;< br />d) nasal intubation should not be performed in case of head injury.
2. Breathing:
a) if the patient has a moderate or severe head injury and he cannot independently control the patency of the respiratory tract, use a volumetric capnograph and maintain the ETSO2 indicator at the level of 35-40 mmHg .;
b) oral endotracheal intubation or insertion of a supralaryngeal airway should be used if ventilation with an AMBU bag is not an effective means of maintaining oxygenation and maintaining the target ETSO2 at the level of 35-40 mmHg;
c) in case of a severe head injury with signs of impingement, initiate hyperventilation with a target ETSO2 at the level of 35-40 mmHg. as a short-term option and only in case of severe head injury with signs of impingement.
3. Circulation.
3.1. Management of wounds:
a) control bleeding with direct pressure;
b) apply a moistened sterile bandage to a potentially open skull wound;
c) in the case of an eye injury, apply a moistened physiological solution, a gauze bandage and a protective shield.
3.2. Moderate/severe closed head injury.
BP: avoid hypotension:
a) adults (over 10 years old): maintenance of systolic pressure above or at 110 mm Hg;
b) children: maintenance of systolic pressure:< /p>
Absent.
Reduce disability and mortality from head injuries by:
Adults or children with blunt or penetrating head trauma – presence of altered consciousness or amnesia is not an inclusion criterion.
Absent.
1. Fixation of the cervical spine (see the instruction “Help with spine injury”).
2. Initial examination according to the guideline “General trauma”.
3. Monitoring:
a) continuous pulse oximetry;
b) periodically check BP;
c) initial assessment of neurological status (see Appendix 3) and re-assessment at any what change in thinking;
d) moderate/severe head injury – use continuous ETCO2 waveform if available.
4. Secondary examination (based on the presence of an isolated head injury):
a) head – gently palpate the skull to identify closed/open skull fractures;
b) eyes:
c) nose/mouth/ears – assess the presence of blood/fluid drainage;
d) face – assess the stability of the bones of the facial skull;
e) neck – perform a palpation to detect sensitivity or spinal deformity;
e) neurological examination:
Attention: below is a list that is formed according to the principle of conceptual unification, so the course of interventions may change.
1. Respiratory tract:
a) provide oxygen therapy, the target level of oxygenation is 94-98%;
b) if the patient is unable to independently maintain the patency of the airways, use an oral airway (the nasal airway does not have be used in the presence of extensive facial trauma or a possible fracture of the bones of the base of the skull);
c) oral endotracheal intubation or the introduction of pressure devices can be used if ventilation with an AMBU bag is not an effective means of maintaining oxygenation or if there are permanent obstructions to the patency of the respiratory tract;< br />d) nasal intubation should not be performed in case of head injury.
2. Breathing:
a) if the patient has a moderate or severe head injury and he cannot independently control the patency of the respiratory tract, use a volumetric capnograph and maintain the ETSO2 indicator at the level of 35-40 mmHg .;
b) oral endotracheal intubation or insertion of a supralaryngeal airway should be used if ventilation with an AMBU bag is not an effective means of maintaining oxygenation and maintaining the target ETSO2 at the level of 35-40 mmHg;
c) in case of a severe head injury with signs of impingement, initiate hyperventilation with a target ETSO2 at the level of 35-40 mmHg. as a short-term option and only in case of severe head injury with signs of impingement.
3. Circulation.
3.1. Management of wounds:
a) control bleeding with direct pressure;
b) apply a moistened sterile bandage to a potentially open skull wound;
c) in the case of an eye injury, apply a moistened physiological solution, a gauze bandage and a protective shield.
3.2. Moderate/severe closed head injury.
BP: avoid hypotension:
a) adults (over 10 years old): maintenance of systolic pressure above or at 110 mm Hg;
b) children: maintenance of systolic pressure:< /p>