Head Injuries

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 (2.05)
• 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

• 3% Saline bolus, 250 ml IV or IO
• Keppra 1 gram IV or IO

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 (VALIUM) 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.

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