General management

• An unstable neck fracture should be assumed until excluded by an expert opinion and appropriate investigations.

• Most head injury patients admitted to non-neurosurgical ICUs will have diffuse or local brain injury for which a non-operative approach has been adopted. The Regional Neurosurgery Centre should be contacted if raised intracranial pressure is present as local policy may encourage early bone flap decompression or referral for invasive monitoring (e.g. intracranial pressure, jugular venous bulb O2 saturation).

If a basal skull fracture is suspected (e.g. X-rays, rhinorrhoea, otorrhoea), avoid nasal insertion of feeding or endotracheal tubes.

• Deterioration in conscious level, developing neurological deficits or focal signs (e.g. unilateral pupillary dilatation) should prompt urgent repeat CT scanning for late complications, e.g. subdural haematoma.

0 0

Post a comment