Patient care with head injury

The approach to a traumatized patient at the accident site implies the implementation of coordinated and sequential rescue techniques aimed at safeguarding the health of the patient. The essential steps of an intervention of this type are

1. Assessment of the state of consciousness of the patient
2. Immobilization of the cervical spine
3. Keep open patient’s breathing ways
4. Constant monitoring of the respiratory and circulatory activities
5. Stop the bleeding from any open wounds
6. Rapid and safe transportation to hospital

Once arrived on the accident’s scene, rescuers should make a rapid assessment of the situation and consider the presence of possible mechanisms of injury. The full examination of the traumatized starts from the assessment of vital signs and includes careful monitoring of the state of consciousness, pupillary response and motor response (AVPU system). In the case of accidents in which the patient has suffered a head injury, cervical immobilization is a crucial lifesaving practice. The presence of a cervical spine’s trauma should be assumed in all unconscious patients and in those with an evident direct or indirect injury above the level of the clavicles. In these cases you need to keep head and neck in traction, positioning the cervical collar to prevent excessive movement of flexion or extension of the head. A safe and reliable cervical collar should be rigid and present a physiological central to access patient’s neck in order to carry out investigations and operations such as palpation of the carotid pulses, tracheotomy, management of tracheostomic tubes. It is recommended to use a bivalve collar, that is composed by two separated pieces (a front support and a rear one), because it provides more symmetry and safety during the application phase. It is also recommended the use of a not adjustable device, because only a collar available in multiple different sizes ensures a more suitable adaptation to the anatomy and the shape of patient’s neck. Once applied, the collar can be removed only after patient’s transport to the hospital, where you can prove the absence of injury.