Contents:

Protocol for paging Trauma team The Trauma Team Primary Survey Secondary Survey Radiology Placement Head injuries Spinal Injuries Chest Injury Blunt abdominal Trauma Penetrating abdominal Trauma Urological Injuries Eye Trauma

Hand Injuries Burns Carbon monoxide poisoning Obstetric Trauma Paediatric Trauma Paediatric resuscitation chart Hypothermia Universal Precautions Blood Alcohol Testing Patient transfers into Liverpool Patient transfers out of Liverpool Telephone numbers Acknowledgments

If in Doubt, Seek Neurological Advice

HISTORY

• Mode and Time of injury.
• Initial GCS.
• Duration of loss of consciousness.
• Any obvious neurological signs at the time.
• Trend in GCS since then.
• Background illnesses and medications or drugs, especially alcohol

EXAMINATION

• Assess Glasgow Coma Score.
• Assess limb strength for asymmetry
• Assess pupillary size, asymmetry or lack of pupillary reaction.
• Injury to the scalp, skull, neck, face including cuts, abrasions or bruising and including CSF leakage from ear or nose.

GCS (sum of the best response in each category)

Eye Opening 4 Spontaneous, 3 To Voice, 2 To Pain 1 Nil

Verbal Response 5 Orientated, 4 Confused, 3 Words, 2 Groans, 1 Nil

Motor Response 6 Obeys Commands, 5 Localises Pain, 4 Withdraws from Pain, 3 Abnormal Flexion, 2 Extension, 1 Nil

   This protocol is designed for use with the general protocol for management of trauma patients (and presumes that it has been followed in relation to airway and haemodynamic management). It presumes a brisk clinical examination and appropriate history. If operation is required for other reasons, head injury management may become more difficult.

Consult the duty neurosurgeon.

A. GCS 8 OR LESS.

Action: Call Neurosurgeon.

• Sedate, paralyse and intubate patient
• Ventilate (PCO2 about 30 mm Hg)
• Mannitol 20% lg/kg IVI stat
• Emergency CT scan as soon as possible.
• Peritoneal lavage all patients in this category.

B. GCS 9 -14 WITH FOCAL SIGNS.

Action: Call Neurosurgeon.

• Half hourly neuro observations.
• If decreased GCS go to A above.
• Urgent CT scan ~,vit:n 2 hours.

Action:

• Half hourly neuro observation for 6 hours.
• If decreased GCS develops, or focal signs, go to A above.
• If GCS stable at 6 hours, hourly observation for 12 hours, then 4th hourly for 8 hours.
• At 24 hours if GCS 15 and if home environment supervised, discharge with head injury card.

Action:

• Half hourly neuro observation for 6 hours If decreased GCS develops, or develops focal signs, go to A above.
• If GCS 15 at 6 hours and home environment supervised, discharge with head injury card.

Action:

• Observe half hourly for 4 hours and discharge home with head injury card.

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