HEAD INJURIES/TBI
DESIGNATION OF CONDITION
Traumatic brain injury (TBI) is a cerebral insult from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness. Concussions are periods of confusion or LOC associated with trauma which may have resolved by the time EMS arrives.
EMPHASIS ON PATIENT CARE
1. Increased ICP may cause HTN, bradycardia, and irregular respirations (Cushing’s Triad).
2. Hypotension usually indicates injury or shock unrelated to the head injury and hemorrhage control should be a priority.
3. Monitor and document a change in the level of consciousness
4. Use IV/IO fluids judiciously to avoid hypotension.
5. A single episode of hypoxia, defined as SpO2 < 90% at any time, has been shown in numerous studies to increase death and disability in moderate to severe TBI.
BLS:
1. Primary Management - Assess ABC’s and manage as indicated.
2. Evaluate for Cervical Spine field clearance.
3. Administer oxygen; assist ventilations if needed. SpO2 should be at 100%. Avoid hyperventilation: maintain PCO2 at 35-45 range.
AEMT:
1. Establish an IV of LR or NS.
2. Avoid hypoxia: administer 02 to maintain oxygen saturation at 100%.
3. Avoid hypotension: ideal BP unknown but should be above 90 systolic and higher if possible
4. Avoid hyperventilation: maintain End Tidal CO2 between 35 and 45.
PARAMEDIC:
1. Apply cardiac monitor; treat lethal dysrhythmias concurrently to injury treatments.
2. Intubation should be approached with caution as it has been associated with worse outcomes when performed in the out-of-hospital environment for some patients with traumatic brain injury
3. TXA is not routinely recommended for TBI which is under study.
Reminder: Avoid the three “H Bombs” of TBI: hypoxia, hypotension, and hyperventilation.
DESIGNATION OF CONDITION
Traumatic brain injury (TBI) is a cerebral insult from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness. Concussions are periods of confusion or LOC associated with trauma which may have resolved by the time EMS arrives.
EMPHASIS ON PATIENT CARE
1. Increased ICP may cause HTN, bradycardia, and irregular respirations (Cushing’s Triad).
2. Hypotension usually indicates injury or shock unrelated to the head injury and hemorrhage control should be a priority.
3. Monitor and document a change in the level of consciousness
4. Use IV/IO fluids judiciously to avoid hypotension.
5. A single episode of hypoxia, defined as SpO2 < 90% at any time, has been shown in numerous studies to increase death and disability in moderate to severe TBI.
BLS:
1. Primary Management - Assess ABC’s and manage as indicated.
2. Evaluate for Cervical Spine field clearance.
3. Administer oxygen; assist ventilations if needed. SpO2 should be at 100%. Avoid hyperventilation: maintain PCO2 at 35-45 range.
AEMT:
1. Establish an IV of LR or NS.
2. Avoid hypoxia: administer 02 to maintain oxygen saturation at 100%.
3. Avoid hypotension: ideal BP unknown but should be above 90 systolic and higher if possible
4. Avoid hyperventilation: maintain End Tidal CO2 between 35 and 45.
PARAMEDIC:
1. Apply cardiac monitor; treat lethal dysrhythmias concurrently to injury treatments.
2. Intubation should be approached with caution as it has been associated with worse outcomes when performed in the out-of-hospital environment for some patients with traumatic brain injury
3. TXA is not routinely recommended for TBI which is under study.
Reminder: Avoid the three “H Bombs” of TBI: hypoxia, hypotension, and hyperventilation.