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Introduction
  • 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.
Clinical Presentation
  • Mechanism or pattern of injury suggesting head trauma.
  • Abnormal behaviour or deteriorating mental status / abnormal neurological exam:
    • Asymmetric or non-reactive pupils
    • Visual disturbances/headaches
    • Seizures
  • Possible CSF leakage
  • Periorbital / retroauricular bruising (Raccoon eyes / Battle’s sign)
  • Indicators of raised ICP:
    • Systolic hypertension / widening pulse pressure
    • Bradycardia, abnormal respirations. i.e. “Cushing’s triad”.
Exclusion Criteria
Exclusion Criteria
Risk Assessment
  • 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.
Management
Primary Care
Intermediate Care (EMT / Level 2)
  • Administer pain relief
  • Consider applying cardiac monitor if trained and authorised
  • Monitor patient persistently, recording full observations every 10 minutes (or 5 minutes if time critical)
  • Transport Priority 1 if patient time critical, pre-notifying receiving facility
Advanced Care (AP)
Critical & Extended Care (CCP, PSO)
  • As per Advanced Care (AP) guidelines
Additional Information
  • Seizures
  • Combativeness or agitation
  • Clinical deterioration
  • Death

References
References
Key Terms & Links
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