The management of head injuries is directed towards preventing the secondary causes of brain damage.
There is a set plan for the management of head injuries:
- observation of normal ATLS protocols
- assessment of severity of injury
- assessment of need for skull x-ray
- assessment of need for admission
- assessment of need for neurological consultation
- management of consequences of injury
Additional factors that must be borne in mind in the management are alcohol intoxication, diabetes, MI, strokes and epilepsy.
Tranexamic acid use in head injury
- for people with a head injury and a GCS score of 12 or less who are not thought to have active extracranial bleeding, consider (3):
- a 2 g intravenous bolus injection of tranexamic acid for people 16 and over
- a 15 mg/kg to 30 mg/kg (up to a maximum of 2 g) intravenous bolus injection of tranexamic acid for people under 16
- give the tranexamic acid as soon as possible within 2 hours of the injury, in the pre-hospital or hospital setting and before imaging
Notes (1):
- priority for all emergency department patients is the stabilisation of airway, breathing and circulation (ABC) before attention to other injuries
- depressed conscious level should be ascribed to intoxication only after a significant brain injury has been excluded
- all emergency department clinicians involved in the assessment of patients with a head injury should be capable of assessing the presence or absence of the risk factors in the guidance on patient selection and urgency for imaging
- patients presenting to the emergency department with impaired consciousness (GCS less than 15) should be assessed immediately by a trained member of staff
- in patients with a GCS less than or equal to 8 there should be early involvement of an anaesthetist or critical care physician to provide appropriate airway management
- all patients presenting to an emergency department with a head injury should be assessed by a trained member of staff within a maximum of 15 minutes of arrival at hospital
Reference:
- NICE (September 2007). Triage, assessment, investigation and early management of head injury in infants, children and adults.
- NICE (January 2014). Triage, assessment, investigation and early management of head injury in infants, children and adults
- NICE (May 2023). Head injury - Triage, assessment, investigation and early management of head injury in children, young people and adults