Head Injury; Roadside to Resus

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Jul 16, 2018

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ADVICE

Triage Importance

Identifying patients with potential head injuries who need an MTC rather than a TU is crucial.
Pre-hospital providers should conduct thorough neuro exams and consider scene details to ensure appropriate triage.

ADVICE

Thorough Assessment

Assess head injury patients thoroughly, starting with A to E.
Pay close attention to GCS, neurological assessment, and pupil reactivity, considering other differentials like hypo/hyperglycemia.

ADVICE

Pre-Hospital Management Goals

Pre-hospital head injury management aims to minimize secondary injury by maintaining cerebral perfusion pressure, ensuring adequate oxygen delivery, and reducing brain metabolic demands.
This involves managing hypotension, avoiding hypoxia, and controlling seizures.

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Head injury worldwide is a significant cause of morbidity and mortality.

Besides prevention there isn't anything that can be done to improve the results from the primary brain injury, there is however a phenomenal amount that can be done to reduce the secondary brain injury that patients suffer, both from a prehospital and in hospital point of view.

In the podcast we run through head injuries, all the way from initial classification and investigation, to specifics of treatment including neuro protective anaesthesia and hyperosmolar therapy, to give a sound overview of the management of these patients.

As always we welcome feedback via the website or on Twitter and we look forward to hearing from you.

Enjoy!

Simon, Rob & James

References & Further Reading

Risk of Delayed Intracranial Hemorrhage in Anticoagulated Patients with Mild Traumatic Brain Injury: Systematic Review and Meta-Analysis. Chauny JM. J Emerg Med. Jul 26 2016

Mannitol or hypertonic saline in the setting of traumatic brain injury: What have we learned? Boone MD. Surg Neurol Int. 2015

Life in the fast lane; hypertonic saline

Life in the fast lane; Traumatic brain injury

Traumatic brain injury in England and Wales: prospective audit of epidemiology, complications and standardised mortality. T Lawrence. BMJ Open. 2016

Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. M.Majdan. The Lancet. 2016

The inefficiency of plain radiography to evaluate the cervical spine after blunt trauma. Gale SC. J Trauma. 2005

What is the relationship between the Glasgow coma scale and airway protective reflexes in the Chinese population? Rotheray KR. Resuscitation. 2012

NICE Head Injury Guidelines 2014

MDCALC Canadian Head Injury

TheResusRoom; The AHEAD Study

TheResusRoom; Anticoagulation, head injury & delayed bleeds

Management of Perceived Devastating Brain Injury After Hospital Admission; A consensus statement

A case for stopping the early withdrawal of life sustaining therapies in patients with devastating brain injuries. Manara AR. J Intensive Care Soc. 2016