Comatose. Less than 8 points on the Glasgow Coma Scale.
Moderate head injury. GCS total of 9 to 12 points.
Mild head injury. A total point count of 13 to 15 on the Glasgow Coma
5-10. GENERAL MANAGEMENT OF HEAD TRAUMA
Follow these general principles in managing patients with possible head trauma:
a. Focus on maintaining adequate oxygen and cerebral blood flow.
b. Hyperventilate (increased amount of air) to decrease the increased
intracranial pressure and prevent brain stem herniation by causing vasoconstriction
(narrowing of blood vessels).
c. Maintain an airway. This is critical since the injured brain has increased
d. Prevent coughing, bucking, seizing since any of these will raise intracranial
e. Intubate early, if possible, since a head trauma patient will frequently aspirate
(intake of foreign material into the lungs during the act of breathing).
f. Protect the cervical spine.
g. Prepare to suction. Patients with head injuries often vomit.
h. Control bleeding and reestablish circulation.
If direct pressure is used to control scalp wounds, remember to press only on
a stable skull.
i. Be alert for shock. Start an IV of lactated Ringer's solution to keep a vein
open and adjust the rate to the patient's needs.
j. Be observant of possible internal injury. Shock without gross bleeding will not
be caused by brain injury except at the terminal stage. The patient may have internal
k. Head injury with multiple trauma should be managed the same as any other
patient in shock. Establish an IV with an electrolyte solution and use a pneumatic
antishock garment such as MAST, if necessary and appropriate to control bleeding.