Cl-P Protocols Head Trauma

Front 1

Specific info needed (subjective)

Back 1

A.History: MOI, estimated force involved, change in LOC since injury, amnesia prior to and following trauma, helmet worn?

B. Past history: medical problems, medications

Front 2

Specific physical findings (objective)

Back 2

A. Vital Signs (note respiratory pattern and rate) and skin signs

B. Pupils (equality and reactivity)

C. Mental status/GCS

D. Assess for signs of cerebral herniation...
Unresponsive PT WITH bilateral dilated pupils

OR

asymetric pupils and abnormal extension (decrebrate posturing) or no motor response to painful stimuli

Front 3

Treatment

Back 3

A. assess and support ABC's with C-spine fully immobilized
B. O2 therapy, assist if needed
C. Intubate if signs of significant head injury ie GCS less then 9, ventilate at 12-14
D. if capnography available, maintain end tidal CO2 around 35
E. Stop bleeding with direct pressure
F. As soon as possible, immobilize spine with firm collar and cervical immobilization device or KED to full spine board
G. Immediate transport with frequent monitoring of vitals and LOC
H. start IV titrate to pt status, 90 systo
I. cardiac monitor

Front 4

specific precautions

Back 4

A. head injuries are load and go, IV enroute
B. C spine all pt's with head trauma that appears significant, or is accompanied by ALOC, nuero deficits, or pain or deformity to the spine
C. be alert for airway problems and or seizure activity. If indicated careful ET intubation is acceptable if C spine is maintained
D. outine hyperventilation no longer recommended
E. GCS < 9 is indicated for intubation
F. restlesness can be a sign of hypoxia
G. most important info is time sequence of LOC, is the patient stable, deteriorating or improving?
H. If in shock, look for other causes, give fluid, shock takes priority
I. Bleeding my be stopped by direct local pressure, if unstable skull, periphery pressure