Administer IV fluids and titrate blood pressure to 90 – 100 mmHG systolic in head injured patients who are hypotensive. Hypotension caused directly by a head injury is a rare and ominous finding it is more often caused by shock associated with other injuries. Administer oxygen via nasal cannula, non-rebreather mask, or bag valve to maintain a pulse-ox reading of at least 95%.Ĭerebral oxygen delivery is also compromised by hypotension, which is associated with poor outcomes after even transient episodes.
#Icp unequal pupil size skin
Use pulse-oximetry, skin color, and respiratory rate to assess adequate oxygenation. Irreversible brain damage can occur in TBI patients after only four minutes of anoxia, which can be caused by a compromised airway, altered respiratory patterns from the head injury, or lung injury in multi-system trauma. Hypoxia and hypotension are harmful – even for a short time Remember that the goal for airway management should be to use the least invasive means to maintain a clear path for oxygenation and ventilation. This procedure carries considerable risk, and whether it should be done by ground EMS crews is controversial.
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Use an oral or nasal airway if the patient will tolerate it, position the patient on their left side to help prevent aspiration, and suction secretions.Įndotracheal intubation is the definitive airway management for TBI, often after sedation and paralysis with RSI.
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Attempt to open the airway with a jaw thrust. Clenched teeth, known as trismus, is another common finding that makes position and suctioning airway secretions difficult. The gag reflex may also be compromised in TBI patients, which increases the risk of aspiration from vomit or blood. Unconscious head-injured patients may lose muscle tone in their jaw, and their tongue may obstruct the airway. Airway compromise from TBI comes in many forms Know which hospitals these are, initiate transport as quickly as possible, and alert the hospital to prepare staff and equipment for your arrival. Transporting patients to trauma centers that offer neurological services, and early activation of teams at these centers, streamlines the process to definitive care. Time is brain, and the chance of disability or death increases with any delay.
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Treatment for head-injured patients requires rapid assessment, imaging with a CT scan, and possibly neurosurgery. Remember that internal injuries cannot be ruled out, particularly those involving the spinal cord, so take spinal precautions in any patient with a head injury and altered mental status. Rely on inspection, auscultation, and palpation to rule in other injuries, such as a change in the patient’s facial expression when their abdomen is palpated. Assume that altered mentation is caused by a head injury instead of intoxication. They may be unable able to follow commands or report pain, and concurrent drug or alcohol intoxication makes assessment even more difficult. Patients with TBI may be confused, combative, or unresponsive.
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Head injured patients are unreliable historians Through airway protection, oxygenation or ventilation, blood pressure maintenance, and transport to a trauma center, EMS plays a vital role in stopping this cascade. The subsequent edema and bleeding from the primary injury then spreads to damage other areas of the brain, and treatment is aimed at limiting this secondary injury. Slow down the damage from secondary brain injuryīrain tissue does not regenerate, thus damage from the initial insult is generally permanent. Signs of increased ICP include altered mental status, unequal or nonreactive pupils, posturing, or seizures, as well as bradycardia and hypertension (Cushing’s Phenomenon). The higher and longer ICP rises, the degree of permanent disability and likelihood of death increases. As ICP increases, sections of the brain may shift to different areas within the skull, or into the opening where the spinal cord enters the cranium, through a process known as herniation. Bleeding and inflammation cause a rise in intracranial pressure (ICP), which squeezes and damages brain structures, within that space. The brain is tightly enclosed within the skull. Trauma: 10 things you need to know to save lives