What are the 2 Hs?
Head
Hypothermia
What are the 3 stages of hypothermia?
Mild, 32-35’C(normal hr,resp, shivering, vasoconstriction-cold extremities)
Moderate28-32’C(decreased hr,resp, no shivering)
Severe<28(decreased loc, cardiac arrest)
5.1 Hypothermia what are the steps?
Assess pt
Handle pt gently
ABCs(defib less likely to work)
Hypoglycaemia? If yes go to 4.5 Hypoglycaemic Emergency
Saline Lock
Get pt off ground, remove wet clothing, insulate/shield from elements
Passive rewarming(dry warm clothes)
Active rewarming(hot packs)
Sma
Foley Catheter
Transport
What are the 2 protocols for TBI? Which do you use?
3.7 mTBI (mild) - class B.
Head injury with altered LOC, or concussion symptoms(headache, irritability, sleep disturbances, fatigue, difficulty concentrating, dizzy, photo/phonophobia)
3.10 sTBI (severe) - class a with a cpl skill
GCS<8, red flags are: witnessed loss of consciousness, 2+blasts in 72 hours, unusual behaviour, vision change, weak side of body, disorientation, worsening headache, unequal pupils, seizure, abnormal speech, vomiting)
Progressive worsening symptoms indicate mild to become severe TBI with brain herniation
Per 3.10 Severe TBI, what are the signs of impending brain herniation?
Dilated/unreactive pupils
Progressive neuro deterioration
Cushings Triad(increase SBP, bradycardia, irregular resps)
Extensor posturing
Asymmetric Pupils
What to do if herniation of brain stem?
Secure airway
Elevate head 30’
Hyperventilate 20rr or EtCO2 target of 30mmHg until herniation signs improve max 20min. Use O2.
Maintain SBP>110 if no hemmorage, if hemmorhage maintain to >100.
Cpl can give 250mL bolus 3% Hypertonic Saline over 20min. X3 prn
Seizures refer to 4.2 Seizure Protocol.
What Med Tech Management of mTBI can we do?
Headache (pain protocol)
Hydration
Rest(reduce stimulus)
Reassess every 6hours for min 24 hours
Update SMA
