Adult patient presenting with signs, symptoms, and history of traumatic injury to the head which may result in an altered level of consciousness, increased blood pressure, lowered pulse rate, and decreased respiratory effort. Shock is rarely the result of direct head injury, look for other causes.

1. Perform patient assessment and ABC's.
2. Immobilize cervical spine with rigid collar and head immobilization device on spine board.
3. Control bleeding with direct pressure. Use caution with unstable skull fractures.
4. Administer oxygen via a device, which will assure adequate patient oxygenation.
5. Prepare for airway problems and/or seizure activity.
6. Measure blood glucose level using Glucometer and document.
7. Be prepared to assist ventilations with BVM as necessary. If ventilations are assisted, do not hyperventilate unless patient has signs and symptoms indicating gross acidosis (ie, posturing)
8. If patient does not have hypotension or other injuries that prevent, elevate patient's head 10-15 degrees. (Elevating head end of LSB is acceptable)
9. Monitor vital signs in accordance with S.O.P.protocol. Evaluate LOC and GCS repeatedly on scene and during transport. Note specific changes in level of consciousness and report them to the receiving facility/physician.
10. Transport as soon as possible. Additional treatment, including IV's may be administered en route.
11. Request ALS Intercept if patient status Critical.

INTERMEDIATE LIFE SUPPORT

1. Initiate IV access using an isotonic solution. Adjust infusion rate to support patient vitals, (goal is systolic BP @100 +/- 10mm Hg). (Do not over hydrate a head-injured patient without other indications for fluid resuscitation, but avoid hypotension).
2. Request ALS Intercept if patient status Critical.

ADVANCED LIFE SUPPORT

1. If patient's overall condition is unstable, attach ECG monitor.
2. Consider aggressive airway management. 'Pre-crash' airway management is always preferable over 'Failed' airway management. Keep in mind however that intubation can cause increases in ICP. Intubation attempts should be swift, precise and kept to a minimum.