1. Head injury assessment

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

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

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

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

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

7. 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

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

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

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

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

12. 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

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

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