Traumatic Head Injury

Traumatic Head Injury (CPG A0803)

General notes

The Trauma Time Critical Guidelines require patients with serious blunt trauma to a single region to
be triaged to the highest level of care. When assessing pattern of injury, the patient can be
considered to have a serious blunt head injury with or without loss of consciousness / amnesia and
GCS 13 - 15 with any of:
- any loss of consciousness exceeding 5 minutes
- skull fracture (depressed, open or base of skull)
- vomiting more than once
- neurological deficit
- seizure
Elderly patients with standing height falls who meet no other time critical criteria but are on anticoagulant, antiplatelet agents or have bleeding disorders should not be underestimated. Transport to
an appropriate level of care.
Intoxicated patients with apparently minor MOIs (e.g. standing height fall) are at high risk of occult
clinically significant head injury.

General care

Midazolam should not be used to control combativeness prior to RSI in head injury. Judicious opioid
pain relief should be administered.
In the rare circumstance where combativeness is preventing preoxygenation, then all other
preparations for the RSI should be undertaken and a small (20 – 40 mg) bolus of Ketamine may be
given to enable preoxygenation.
Where the patient is severely agitated, manage with ketamine as per CPG A0708 Agitation
Dress open skull fractures / wounds with an appropriate dressing.
Consider spinal immobilisation as per CPG A0804 Spinal injury. If intubation is required, apply
cervical collar after intubation. Attempt to minimise jugular vein compression.
Attempt to maintain normal body temperature.
If an adequate blood pressure cannot be achieved or there are other signs of unacceptably poor
perfusion or deterioration, consult for further management. Options include further fluid or the use of
pressors.

Flow Chart