Pre hospital
management of head
injury
Dr Deepak Agarwal
Sr consultant Neurosurgeon
VPS Rockaland Hospital
Affect
millions of people
Majority in prime of their life
Important cause of
mortality/disability
HEAD INJURY
Physiological
and
biochemical changes
soon after head trauma
Awareness of role of
ischemia in first 24 hrs
following head injury,
commonly known as
secondary injury.
Secondary injury
manifest within
minutes or hours after
primary insult
Morbidity
and Mortality of severe
head injury be reduced by
securing and maintianing airway
and provide ventilation
Also facilitates timely medical
and surgical care
Why Prehospital care
Immediate
care of airway and
breathing
Prompt restoration and maintenance
of hemodynamic stability
Provide optimal environment for the
brain by taking care of ICP
Take adequate care of associated
injury
Transport patient to most appropriate
multidisciplinary hospital
Penetrating
or blunt injury ?
Stop external bleeding
Head and neck collars for spinal
protection is mandatory in
unconscious patient.
Institute A-B-C AVOID
HYPOXIA AND HYPOTENSION
Initial assessment and care
Oxygen
by face mask
INTUBATE IF
Coma- GCS<8
Loss of protective reflex
Severe maxillofacial injury
Significant bleeding from oral
cavity
seizure
Indication of intubation
Infusion
of normal saline is
recommended
Maintain blood pressure- by infusion
of crystalloid or colloid
Transfuse blood/ vasopressor if BP still
low despite fluid resuscitation
Glucose containing fluid
contraindicated especially in
prehospital setting- may aggravate
ischemia an edema
Fluid resuscitation
Dopamine
very popular
However it causes tachycardia,
and aggravation of brain edema
and may suppress anterior
pituitary hormones
Noradrenaline increases brain
tissue oxygenation and cerebral
perfusion
vasopressor
Continuous
monitoring of BP,
Pulse,Spo2
GCS, Pupil monitoring
Evaluation and care of other
associated injury e.g care of long
bone fracture, chest injury such
as hemo/ pneumothorax
Monitoring
Transport to nearest facility equipped to
deal with head injury and polytrauma
pateints
Head is elevated to 15-30 degree
Rigid collar for cervical spine
Unstable fracture should be immobilized
COMPETENT SYSTEM OF TRASPORT
WITH THE PATIENT PACKED TOGETHER
WITH MONITORING AND THERAPEUTIC
DEVICE
Transportation
