Closed Head Injuries
First Things First (assess & treat for the following):
- Ensure airway and breath sounds.
- Ensure IV access and perfusion.
- What is the current neuro status?
- Determine Glasgow Coma Score (GCS); see “History and Physical” section
- Serial neuro exams
- Action for deteriorating exam
- Lateralizing findings (ie, hemiparesis; suggest surgical lesion)
- Hypoxic or hypotensive?
- Correct ASAP to prevent further ischemia.
- Intubation if GCS 8 or less
- Maintain O2 sat >90%.
- Maintain SBP >90 mmHg (increased mortality for each hypotensive or hypoxic episode).
- C-spine protected?
- Frequent co-injury w/ traumatic brain injury (TBI)
- Other injuries are difficult to identify & treat in TBI pts.
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