Closed Head Injury Algorithm Your Trauma Guide
Closed Head Injury Algorithm Your Trauma Guide A closed head injury, also known as a traumatic brain injury (TBI), occurs when an external force impacts the skull without penetration into the brain tissue. These injuries can range from mild concussions to severe brain damage, making prompt assessment and management crucial. An organized algorithm provides clinicians with a structured approach, ensuring vital steps are not missed and patient outcomes are optimized.
The initial step in managing a suspected closed head injury is to ensure scene safety and perform a primary survey, focusing on airway, breathing, and circulation (ABCs). Securing the airway is paramount, especially if the patient exhibits decreased consciousness or compromised airway reflexes. Adequate oxygenation and ventilation are essential to prevent secondary brain injury caused by hypoxia or hypotension. It’s vital to monitor vital signs continuously and establish IV access for fluid resuscitation if needed.
Next, a rapid neurological assessment should be performed using tools like the Glasgow Coma Scale (GCS). This helps determine the severity of the injury—mild (GCS 13-15), moderate (GCS 9-12), or severe (GCS ≤8). Patients with a GCS score of 8 or less often require airway protection via endotracheal intubation. Concurrently, look for other signs such as pupillary abnormalities, limb weakness, or abnormal posturing, which may indicate intracranial pressure or herniation.
Imaging plays a pivotal role in diagnosis. A non-contrast computed tomography (CT) scan of the head is the gold standard for acute assessment. It helps identify intracranial hemorrhages, skull fractures, edema, or mass effect. If the CT scan reveals significant pathology—such as subdural or epidural hematomas, diffuse axonal injury, or cerebral contusions—urgent neurosurgical consultation is warranted.
Once stabilized and imaging is obtained, management focuses on preventing secondary brain injury. This involves maintaining optimal cerebral perfusion pressure by controlling blood pressure (avoiding hypotension, typically maintaining systolic BP >100 mm Hg) and ensuring adeq
uate oxygenation (SpO2 >94%). Elevated intracranial pressure (ICP) may require interventions like head elevation, hyperosmolar therapy with mannitol or hypertonic saline, and sedation. In refractory cases, surgical options such as decompressive craniectomy should be considered.
Close neurological monitoring is essential throughout treatment. Repeat imaging may be necessary if clinical deterioration occurs. Managing intracranial hypertension, preventing seizures, and addressing systemic complications like hypoxia, hypotension, or metabolic disturbances are integral parts of ongoing care. Patients with moderate to severe injuries often need ICU admission for continuous monitoring.
In the recovery phase, a multidisciplinary approach involving neurorehabilitation, physical therapy, and cognitive support is vital. Prevention of secondary injuries and addressing psychological impacts are key to long-term outcomes.
This algorithmic approach to closed head injuries ensures a comprehensive, timely, and effective response—reducing morbidity and improving survival chances. Trauma teams trained in this structured pathway can deliver consistent, evidence-based care, ultimately saving lives and aiding recovery.
