Head Injury
Severe Head Injury

* Primary injury: Biomechanical
Contusions, lacerations, diffuse vascular injuries, intracranial haemorrhage
Severe Head Injury - objectives

* Monitor for neurological deterioration during other procedures
* Perform neuro-resuscitative measures when indicated
* All airway manipulation with cervical spine immobilisation
5 - 17% prevalance of cervical spine fractures in patients with severe head injuries
* Control oxygenation and ventilation
Aim for PaCO2 ~ 30 mmHg, no PEEP
* Optimise cerebral venous drainage
Keep paralysed, posture, avoid neck compression
* Maintain high “normal” cerebral perfusion pressure
* Maintain sedation
* Fluid resuscitation with isotonic fluids
* Correct anaemia: aim for ~ Hb 100gm/L
* Anaesthesia drugs ­ no cerebral vasodilators
* Seek neurosurgical advice early
* Don’t waste time
* Rapid diagnosis of intracranial pathology
* Immediate definitive management (surgical)
Indications for Intracranial Pressure monitoring

* Severe head injury
Defined as a GCS of 3 - 8 after CPR
* And Abnormal CT scan with
* Contusions
* Haematomas
* Oedema
* Or compressed basal cisterns