string(11) "/protocols/"

24.0 HEAD INJURIES

All Providers

  • Focused history and physical exam
  • Cardiac monitor, ETCO2 if available, pulse oximetry
  • Treatment Plan
    • Maintain airway, administer oxygen to maintain SaO2 90-94%
    • Consider Selective Spinal Motion Restriction Protocol
    • Monitor level of consciousness during transport
    • Avoid hyperventilation, hypoxia, hypotension
    • Consider targeted hyperventilation with targeted ETCO2 of 30-35 mmHg with extensor posturing
  • Cover skull fractures with dry, sterile dressings

Adult

EMT
AEMT
  • Advanced airway, vascular access and fluid therapy per IV/IO Access and Shock and Fluid Therapy Protocol
  • BP every 5-10 minutes
  • Follow the Traumatic Brain Injury pressure management under the Shock and Fluid Therapy Protocol
Paramedic
  • Persistent hypotension: Norepinephrine 0.3-3 mcg/min IV/IO infusion, titrate SBP >100 mmHg
  • Consider Rapid Sequence Intubation Protocol
  • Consider Pain Management Protocol

Pediatric
not to exceed adult dose

EMT
AEMT
  • Advanced airway, vascular access and fluid therapy per IV/IO Access and Shock and Fluid Therapy Protocol
  • BP every 5-10 minutes
  • Initiate LR 20 ml/kg for hypotension OR unable to obtain blood pressure
  • Repeat LR 20 ml/kg times one for ongoing hypotension
Paramedic
  • Persistent hypotension: Norepinephrine 0.05-0.1 mcg/kg/min IV/IO infusion, titrate to max of 2 mcg/kg/min to maintain SBP >70 + (age in years x 2) mmHg
  • Consider Rapid Sequence Intubation Protocol
  • Consider Pain Management Protocol