Advanced Trauma Life Support ATLS Student Course Manual 2018

BIBLIOGRAPHY 125
2. Patients with head and brain injuries must be
evaluated efficiently. In a comatose patient,
secure and maintain the airway by endotracheal
intubation. Perform a neurological examination
before paralyzing the patient. Search for associated
injuries, and remember that hypotension can affect
the neurological examination.
3. Trauma team members should become familiar with
the Glasgow Coma Scale (GCS) and practice its use, as
well as performance of rapid, focused neurological
examinations. Frequently reassess the patient’s
neurological status.
4. Adequate resuscitation is important in limiting
secondary brain injury. Prevent hypovolemia and
hypoxemia. Treat shock aggressively and look for
its cause. Resuscitate with Ringer’s lactate solution,
normal saline, or similar isotonic solutions without
dextrose. Do not use hypotonic solutions. The goal
in resuscitating the patient with brain injuries is
to prevent secondary brain injury.
5. Determine the need for transfer, admission,
consultation, or discharge. Contact a neurosurgeon
as early as possible. If a neurosurgeon is not
available at the facility, transfer all patients with
moderate or severe head injuries.
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