HEAD INJURY (TRAUMATIC BRAIN INJURY)
DESIGNATION OF CONDITION

Signs and symptoms may include any or all of the following: slowing pulse rate, increasing blood pressure, increasingly irregular respiratory patterns, altered level of consciousness, unequal pupils, repeating speech patterns, seizures, presence of CSF, with a history of head trauma.

EMPHASIS ON PATIENT CARE
Airway management, adequate oxygenation, spinal precautions.
Be aware of the potential for spinal, abdominal or chest trauma not apparent due to altered mental status.

First Responder & BASIC PRE-HOSPITAL MANAGEMENT
1. Initial Management - Assess airway, breathing and circulation and manage as indicated. BGL If the patient requires assisted ventilations, these should occur at 12- 16 breaths per minutes with adequate tidal volume. Recommend use of capnometry/capnography (Basic and Above) to maintain CO2 levels between 28-32 torr.
2. Transport the patient as soon as possible to an appropriate medical facility. Consider from the field Air Evac with on-line Medical Control orders.
3. Focused H&P - History, physical exam, vital signs, and Glasgow Coma Scale.

INTERMEDIATE and PARAMEDIC PRE-HOSPITAL MANAGEMENT
4. Consider ET intubation (paramedic level).
5. En-route, initiate an IV of an isotonic solution at a rate to maintain adequate vital signs. Consider second IV, if indicated.
6. Use a Buretrol IV set for pediatrics. Consider intraosseous access, if peripheral venous access is not available and patient conditions warrants.
7. PARAMEDIC ONLY: Consider administration of DEXAMETHASONE [4-10 mg] per Medical Control.

SEE GLASCOW COMA SCALE AND TRAUMA SCALE ON NEXT PAGE

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TRAUMA SCORE