A systematic approach to the trauma patient with a suspected head injury is essential in order to provide an expedient diagnosis and treatment. The head is one of the most commonly injured structures of the body; trauma can cause a constellation of symptoms including a decrease in mental status or loss of consciousness. Other etiologies of loss of consciousness must also be considered including shock, seizures, metabolic disturbances, and intoxication.
As with all trauma patients, ATLS (Advanced Trauma Life Support) guidelines recommend management of the “A, B, C’s” (Airway, Breathing, and Circulation) first. Patients who are spontaneously breathing may be observed. However, patients who present with altered mental status and inability to protect their airway need to be intubated, either orally or nasally. Head-injured patients have a high likelihood of cervical spine injury; therefore, cervical spine stabilization should be maintained at all times, even when intubating. Breathing should be assessed next with auscultation of the chest cavity for breath sounds. Definitive treatment is needed for pneumoor hemothorax or other injuries affecting ventilation. Circulation is assessed by taking the patient’s pulse and blood pressure. Two large-bore peripheral IVs should be placed and resuscitation started with crystalloid fluid and blood, if needed for severe hypotension. Hypotension and hypoxemia can be devastating for the patient with a head injury and may actually cause secondary insult to the brain. All efforts should be made to maintain blood pressure and oxygenation for adequate cerebral perfusion.
KeywordsGlasgow Coma Scale Subdural Hematoma Epidural Hematoma Glasgow Coma Scale Score Skull Fracture
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