Traumatic brain injury, also known as head injury or intracranial injury is the result of physical trauma causing brain damage and can result from a closed or penetrating head injury. It is classified as mild, moderate or severe and can also be divided into two separate categories; primary and secondary brain injury.
Mechanism or pattern of injury suggesting head trauma.
Abnormal behaviour or deteriorating mental status / abnormal neurological exam:
Bradycardia, abnormal respirations. i.e. “Cushing’s triad”.
Primary injury is generally irreversible therefore the aim of treatment is to prevent secondary injury by supporting cerebral haemodynamics and metabolism. Hypoxia and hypotension cause the most prominent secondary injuries and may more than double mortality.
Hyperventilation should be avoided as it exacerbates cerebral ischaemia and can reduce venous return. It is generally used as a last resort where signs of impending cerebral herniation are evident.
Exercise caution when considering Nasopharyngeal Airway during treatment of a patient with a suspected base of skull fracture.