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Primary Trauma Care Manual - part 3

Đường hàng không, hơi thở và lưu hành được ổn định (và cột sống C-bất động, nếu có thể). Những dấu hiệu quan trọng của chỉ số quan trọng trong tình trạng thần kinh của bệnh nhân phải được theo dõi và ghi lại thường xuyên. Glasgow Coma Điểm (GCS) đánh giá được thực hiện: | Primary Trauma Care The most common error in head injury evaluation and resuscitation are failure to perform ABC and prioritise management failure to look beyond the obvious head injury failure to assess the baseline neurological examination failure to re-evaluate patient who deteriorates. Management of Head Trauma The Airway Breathing and Circulation are stabilised and the C-spine immobilised if possible . Vital signs of important indicators in the patients neurological status must be monitored and recorded frequently. Glasgow Coma Score GCS evaluation is undertaken see Appendix 4. Remember severe head injury is when GCS is 8 or less moderate head injury is when GCS between 9 and 12 minor head injury is when GCS between 13 and 15. Deterioration may occur due to bleeding unequal or dilated pupils may indicate an increase in intracranial pressure head or brain injury is never the cause of hypotension in the adult trauma patient sedation should be avoided as it not only interferes with the status of consciousness but will promote hypercarbia slow breathing with retention of CO2 the Cushing response is a specific response to a lethal rise in intracranial pressure. This is a late and poor prognostic sign. The hallmarks are bradycardia hypertension decreased respiratory rate. Basic medical management for severe head injuries includes intubation and hyperventilation producing moderate hypocapnia PCO2 to 4.5-5 Kpa . This will reduce both intracranial blood volume and intracranial pressure temporarily sedation with possible paralysis moderate IV fluid input with diuresis i.e. do not overload nurse head up 20 prevent hyperthermia. Never assume that alcohol is the cause of drowsiness in a confused patient Primary Trauma Care Spinal Trauma The incidence of nerve injury in multiple trauma is higher than expected. The most common injuries include damaged nerves to fingers brachial plexus and central spinal cord. The first priority is to undertake the primary survey with .