Advanced Trauma Life Support ATLS Student Course Manual 2018

112
CHAPTER 6 n Head Trauma
covery. Vigorous management and improved understanding
of the pathophysiology of severe head
injury, especially the role of hypotension, hypoxia,
and cerebral perfusion, have significantly affected
patient outcomes. n TABLE 6-3 is an overview of
TBI management.
Management of Mild Brain Injury
(GCS Score 13–15)
Mild traumatic brain injury is defined by a postresuscitation
GCS score between 13 and 15. Often
these patients have sustained a concussion, which is
a transient loss of neurologic function following a head
injury. A patient with mild brain injury who is conscious
and talking may relate a history of disorientation,
amnesia, or transient loss of consciousness. The history
of a brief loss of consciousness can be difficult to
confirm, and the clinical picture often is confounded by
alcohol or other intoxicants. Never ascribe alterations
in mental status to confounding factors until brain
injury can be definitively excluded. Management
of patients with mild brain injury is described in
(n FIGURE 6-8). (Also see Management of Mild Brain Injury
algorithm on MyATLS mobile app.)
table 6-3 management overview of traumatic brain injury
All patients: Perform ABCDEs with special attention to hypoxia and hypotension.
GCS
CLASSIFCATION
13–15
MILD TRAUMATIC
BRAIN INJURY
9–12
MODERATE
TRAUMATIC
BRAIN INJURY
3–8
SEVERE
TRAUMATIC
BRAIN INJURY
Initial
Management a
AMPLE history and neurological exam:
ask particularly about use of anticoagulants
Neurosurgery
evaluation or transfer
required
Urgent neurosurgery
consultation or
transfer required
May discharge if admission
criteria not met
Admit for
indications below:
*Primary survey and
resuscitation
*Primary survey and
resuscitation
Determine mechanism,
time of
injury, initial GCS,
confusion, amnestic
interval, seizure,
headache severity,
etc.
*Secondary survey
including focused
neurological exam
No CT available,
CT abnormal, skull
fracture, CSF leak
Focal neurological
deficit
GCS does not
return to 15 within
2 hours
*Arrange for
transfer to definitive
neurosurgical
evaluation and
management
*Focused neurological
exam
*Secondary survey
and AMPLE history
*Intubation and
ventilation for airway
protection
*Treat hypotension, hypovolemia,
and hypoxia
*Focused neurological
exam
*Secondary survey and
AMPLE history
Diagnostic
*CT scanning as
determined by head
CT rules (Table 6-3)
*Blood/Urine EtOH
and toxicology
screens
CT not available,
CT abnormal, skull
fracture
Significant
intoxication (admit
or observe)
*CT scan in all cases
*Evaluate carefully
for other injuries
*Type and crossmatch,
coagulation studies
*CT scan in all cases
*Evaluate carefully for
other injuries
*Type and crossmatch,
coagulation studies
a
Items marked with an asterisk (*) denote action required.
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