Head injuries are common accidents for paramedics to attend and they are also some of the most potentially significant injuries. The only determinant of how significant a head injury has been is time. All head injury patients need to be monitored! It is so easy to leave a patient with a mild head injury at home – in some instance this may be fine, but you must ensure that they have someone around them for the next 4 hours who will be able to watch them and make sure that their neurological condition does not deteriorate!
Head injuries may be caused by an isolated injury or as part of a systemic mechanism of trauma. You can have a primary injury (the person is hit with a baseball bat in the head and receives an immediate injury to the brain) or a secondary injury (person’s heart stops for a short period, and consequently, there is no blood reaching the brain, and the patient’s brain develops a hypoxic brain injury).
How do Paramedics Assess a Head Injury?
1. Thoroughly examine the patient’s ABCDEs – ensure that these people have a clear airway, adequate ventilation (rate and depth) and good circulation. A failing in any one of these will result in secondary damage to the brain due to hypoxia. Thoroughly assess their disability (neurological status) – GCS and AVPU, Pupil sizes and reactivity, and Motor/sensory response by 4 limbs. Assess environmental causes and expose the patient (to look for rashes or other significant causes of a decreased LOC).
2. Consider spinal injuries (remember, if they have had enough trauma to render them unconscious, it is conceivable that they may have damaged their cervical spine). Consider spinal immobilisation with a C-collar, sandbags, and straps.
3. Assess other causes of decreased LOC such as the pneumonic AEIOUTIPS – Alcohol, Epilepsy, Infection, Overdose, Uraemia (problems with the kidneys resulting in too much uraemia in the blood), Trauma, Insulin (high or low BSL), Poisoning and Stroke.
4. Provide oxygen, cannulate, and urgently transport these patients to a hospital with definitive treatment! There is no point taking someone with a bad enclosed head injury (with obvious signs of an increased ICP) to a hospital without neuro-surgical capabilities.
5. Reassess everything!