Protocol 2-484 - Head Trauma

CMH EMS & MIH Protocols

EMD:

No specific protocol.

EMR:

Consider SMR. C-collar is contraindicated with penetrating neck trauma.
Assist Ventilations as needed.
Consider Oxygen 100%.
Consider applying Cardiac Monitor limb leads.
Head crush injury: Immediate release and rapid transport.
Maintain body temperature between 91° and 99° F.
Elevate head of Cot.
Avulsed tooth: Do not touch root. Place in NS.

EMT:

Ensure completion of applicable items above.
Consider assisting ALS with Capnography.
Severe head injury with Cushing's Triad: Moderate hyperventilation to target EtCO2 of 30-35.
If destination facility is on CT divert: Bypass that facility and transport to next closest appropriate facility taking into consideration the patient's wishes.

AEMT:

Ensure completion of applicable items above.
Consider IV LR 20 ml/kg (max 40 ml/kg or 2,000 ml) titrated to maintain SBP according to age.

Click "calculate" to get dose.

Refer to Protocol 2-924 - Universal Patient Care and do not exceed the lower range of the SBP indicated in the Normal Vital Signs table.

RN:

Ensure completion of all applicable items above.
Consider IO LR.
GCS less than 8 OR Cushing's Triad: Consider Protocol 2-044 - Airway: RSI.

Cushing's Triad: Abnormal breathing AND Bradycardia AND Hypertension.

Adult	Pediatric
Consider Fentanyl 50-100 mcg every 5-20 minutes (max 300 mcg) IV/IO/IN. Over 65 years old: 0.5-2 mcg/kg. Click "calculate" to get dose. Nausea: Consider Zofran 4 mg (max 8 mg) IV/IO/IN/IM.	Less than 3 years old: Atropine 0.02 mg/kg (min 0.1 mg) IV/IO. Click "calculate" to get dose. Consider Fentanyl 1-2 mcg/kg (max 150 mcg) IV/IO/IN. May repeat. Click "calculate" to get dose. Consider contacting MEDICAL CONTROL.

Medic:

Ensure completion of all applicable items above.

CP:

Ensure completion of all applicable items above.

NEMSIS Protocol: 9914101 - Injury-Head

Citations:

Protocol 9-010 - References
Feng, Chan, Liu, Or, & Lee, 1996
Flower & Hellings, 2012
Helfman, Gold, DeLisser, & Herrington, 1991
Lin, et al., 2012
NASEMSO Medical Directors Council, 2017
Robinson & Clancy, 2001
Singh, Vichitvejpaisal, Gaines, & White, 1995
Ugur, Ogurlu, Gezer, Nuri Aydin, & Gursoy, 2007

Change Log:

Date	Link to previous version	Description of change
11/19/13	pdf	Changed SMR mandatory to SMR as required.
12/12/14	pdf	Changed target ETCO2 from 30-35 to 40-45. Added comment to maintain patient temperature. Changed LR to NS. Added desired SBP table. Defined Cushing’s Triad. Made Intubation and RSI DELIBERATE ACTIONS. Added weight-based dose for greater than 65 yr for Fentanyl.
12/12/14	pdf	Added RSI indications.
03/02/15		Removed DELIBERATE ACTIONS.
11/17/15		Removed comment that Morphine is contraindicated in head trauma.
07/22/16	pdf	Moved fluid bolus to AEMT section.
09/22/17	pdf	Added contraindication for c-collar for penetrating neck trauma. Added avulsed tooth and epistaxis treatments to EMR. Added moderate hyperventilation for herniation syndrome.
11/11/17	pdf	Removed Lidocaine before intubation.
07/23/19	pdf	Added link to new hemorrhage protocolremoved epistaxis.
11/18/19	pdf	Added comment to bypass CMH if on CT divert by specific order of Dr. Cauchi.
04/18/20	pdf	Added content (without substantive modification) from old Protocol 5-070 - Head Trauma.
06/06/21	pdf	Moved to emsprotocols.online
12/01/21		Updated link to Zofran.
03/15/23	pdf	Clarified RN and medic roles. Added CP.
03/20/23		Changed links for Fent.
03/20/23		Changed link for Atropine.

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