Difference between revisions of "Head Injuries"
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* Elevate head and shoulders 15 - 30 degrees if systolic BP > 90 mm Hg. | * Elevate head and shoulders 15 - 30 degrees if systolic BP > 90 mm Hg. | ||
* Refer to [[Altered Mental Status (AMS)|ALTERED MENTAL STATUS PRACTICE PARAMETER]] (5.03). | * Refer to [[Altered Mental Status (AMS)|ALTERED MENTAL STATUS PRACTICE PARAMETER]] (5.03). | ||
| − | * If '''Combative''' refer to [[ | + | * If '''Combative''' refer to [[DISSOCIATIVE ANESTHETIC]] (2.06) |
* [[Morphine_Sulfate|MORPHINE]] - Initial dose 2-5 mg IVP, IM or IN followed by 2 mg doses. (Max 15 mg) | * [[Morphine_Sulfate|MORPHINE]] - Initial dose 2-5 mg IVP, IM or IN followed by 2 mg doses. (Max 15 mg) | ||
::'''AND / OR''' | ::'''AND / OR''' | ||
| Line 33: | Line 33: | ||
* [[Versed|MIDAZOLAM (Versed)]] - Initial dose 2-5mg IV or IN then 2 mg every 30 seconds to 1 minute. | * [[Versed|MIDAZOLAM (Versed)]] - Initial dose 2-5mg IV or IN then 2 mg every 30 seconds to 1 minute. | ||
** (Max dose 15 mg) in the intubated patient. IM .07-.08 mg/kg with onset in approximately 15 minutes. IM injection requires immediate IV access upon sedation. | ** (Max dose 15 mg) in the intubated patient. IM .07-.08 mg/kg with onset in approximately 15 minutes. IM injection requires immediate IV access upon sedation. | ||
| − | * [[Ativan|LORAZAPAM ( | + | * [[Ativan|LORAZAPAM (Ativan)]] 1-2 mg Slow IVP for adults titrated to effect. Max dose of 8mg. If no IV access or Agitated/Violent behavioral patient, administer 1-2 mg IM up to a total of 2 ml per large muscle injection site or 1 ml per small muscle injection site. |
* These drugs may be given in combination for maximum effectiveness. | * These drugs may be given in combination for maximum effectiveness. | ||
* Ensure that Pulse Oximeter is in place. | * Ensure that Pulse Oximeter is in place. | ||
Latest revision as of 08:23, 17 December 2025
Section 6 - TRAUMA
6.07 HEAD INJURIES
INITIAL TRAUMA CARE, (2.02) OXYGEN @ 100% via NRB mask or hyperventilate with BVM.
- Elevate head and shoulders 15 - 30 degrees if systolic BP > 90 mm Hg.
- Refer to ALTERED MENTAL STATUS PRACTICE PARAMETER (5.03).
- If Combative refer to DISSOCIATIVE ANESTHETIC (2.06)
- MORPHINE - Initial dose 2-5 mg IVP, IM or IN followed by 2 mg doses. (Max 15 mg)
- AND / OR
- KETAMINE (KETALAR) Titrate to effect, starting dose of 0.5 mg/kg slow IVP or 1 mg/kg IM.
- Maintain ETCO2 between 30-35 mmHg and Oxygen saturation >95%
TRAUMATIC BRAIN INJURY MANAGEMENT
- If the following criteria have been met:
- GCS < 8 (Consider airway management with an i-gel if no gag reflex)
- AND Any one of the following:
- Unilateral fixed or dilated pupil
- Unilateral paralysis
- Posturing
- Seizure after injury
- Skull deformity
ADULT
PEDIATRIC
- 3% Saline bolus at 5 ml/kg (max of 250 ml) IV/IO drip utilizing 10ggts drip set
- Keppra 20mg/kg (not to exceed 1g) IV/IO (may be repeated once at 40mg/kg if seizure continues)
- Transport patient to nearest Pediatric Trauma Center via appropriate method
OTHER OPTIONS
- MIDAZOLAM (Versed) - Initial dose 2-5mg IV or IN then 2 mg every 30 seconds to 1 minute.
- (Max dose 15 mg) in the intubated patient. IM .07-.08 mg/kg with onset in approximately 15 minutes. IM injection requires immediate IV access upon sedation.
- LORAZAPAM (Ativan) 1-2 mg Slow IVP for adults titrated to effect. Max dose of 8mg. If no IV access or Agitated/Violent behavioral patient, administer 1-2 mg IM up to a total of 2 ml per large muscle injection site or 1 ml per small muscle injection site.
- These drugs may be given in combination for maximum effectiveness.
- Ensure that Pulse Oximeter is in place.
- Ensure that BVM and ROMAZICON and/or NARCAN are readily available.
[[Category:Trauma|0607]
