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Head Injury Management Algorithms

- The document defines different levels of brain injury based on GCS score: mild (13-15), moderate (9-12), and severe (3-8). - For moderate brain injury (GCS 9-12), the summary includes initial examination, admission or transfer for neurosurgical care, frequent neurological checks, follow-up CT scans if condition deteriorates, and discharge if patient improves. - Management involves assessment, admission or transfer for severe brain injury (GCS 3-8), therapeutic agents like mannitol with neurosurgeon consultation, neurologic reevaluation, and CT scans.

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460 views3 pages

Head Injury Management Algorithms

- The document defines different levels of brain injury based on GCS score: mild (13-15), moderate (9-12), and severe (3-8). - For moderate brain injury (GCS 9-12), the summary includes initial examination, admission or transfer for neurosurgical care, frequent neurological checks, follow-up CT scans if condition deteriorates, and discharge if patient improves. - Management involves assessment, admission or transfer for severe brain injury (GCS 3-8), therapeutic agents like mannitol with neurosurgeon consultation, neurologic reevaluation, and CT scans.

Uploaded by

ravenska
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd

Definition : GCS Score 9-12

Initial examination
- Same as for mild injury, plus baseline blood work
- CT-Scan of the head is obtained in all cases
- Admit or transfer to a facility capable of definitive neurosurgical care

After Admission

- Frequent neurologic checks


- Follow-up CT-Scan if condition deteriorates or preferably before discharge

If patient improves (90%) If patient deteriorates (10%)

• If the patient stops following simple


• Discharge when appropriate commands, repeat, CT-scan and
• Follow-up clinic manage per severe brain injury
protocol

Algorithm for Management of Moderate Brain Injury

Sumber : ATLS 10th ed


Definition : Patients is unable to follow even simple commands because of impaired
consciousness (GCS Score 3-8)

Assessment and management

- ABCDE's
- Primary survey and resuscitation
- Secondary survey and AMPLE history
- Admit or transfer to a facility capable of definitive
- Therapeutic agents (usually administered after consultation with
neurosurgeon) : Manitol, Avoid hyperventilation in the first 24
hours unless signs of herniation, hypertonic saline
- Neurologic reevaluation
-GCS
- Pupillary light response
- Focal neurologic exam

CT-Scan

Algorithm for Initial Management of severe Brain Injury

Sumber : ATLS 10th ed


Definition : Patient is awake and may be oriented (GCS 13-15)

History
Name, age, sex, race, occupation; Mechanism of injury; Time of injury; Loss of
consciousness immediately postinjury; subsequent level of alertness; amnesia
retrograde, Antegrade; Headache (mild, moderate, severe); vomitting

General examination
to exclude systemic injuries

Limited neurologic examination

Cervical spine and other x-rays as indicated

Blood alcohol level and urine toxicology screen

CT-scan of the head is indicated if criteria for high or moderate risk


of neurosurgical intervention are present

Admit or transfer to appropriate facility Discharge from hospital

• Abrnormal CT-Scan • Patient does not meet any of the


• All penetrating head injuries criteria for admission
• History of prolonged loss of • Discuss need to return if any
consciousness problems develop and issue a
• Moderate to severe headache “warning sheet”
• Significant alcohol/drug intoxication • Schedule a follow-up visit
• Skull fracture
• CSF leak : Rhinorrhea or otorrhea
• Significant associated injuries Algorithm for Management of Mild Brain Injury
• No Reliable companion at home (emergency room management of the head-injured patient.
• Abrnormal GCS Score (<15)
• Persistent focal neurologic deficits Sumber : ATLS 10th ed

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