SEVERE HEAD INJURY

RESUSCITATION

Airway - intubate if GCS < 8
Breathing - ventilate if hypoxic or  inadequate ventilation (acute respiratory acidosis)
Circulation - control all sites of bleeding (including scalp laceration), maintain normotension
Disability - treat hypoglyscaemia

Avoid Nasal ETT/NGT in basal skull#

ONGOING MANAGEMENT

MANAGE COMPLICATIONS

Incipient herniation (rapidly deteriorating GCS, evolving focal signs, Cushing's reflex - bradycardia/hypertension, respiratory arrest)

DIC (elevated XDP/FDP/D-dimer, decreased fibrinogen, decreased platelet)

Seizures

Neurogenic pulmonary oedema

(GTN/frusemide generally not required)

INVESTIGATIONS

Urgent CT brain

SURGICAL MANAGEMENT

ICP monitoring

if GCS < 8 and

Clot evacuation (if bleed)

Elevation of bone fragment (if depressed skull #)

Ventricular shunt (if acute hydrocephalus)