• A strong working knowledge of anatomy and physiology of the face, head, and brain is essential to accurately assess and manage patients with injuries to these locations.
  • Personal safety is your primary concern when treating any patient with head or face trauma; never enter an unsafe scene.
  • Head and face trauma most often result from direct trauma or rapid acceleration-deceleration forces.
  • Trauma to the face can range from a broken nose to more severe injuries, including massive soft-tissue trauma, maxillofacial fractures, oral or dental trauma, and eye injuries.
  • Your primary concerns with assessing and managing a patient with facial trauma are to ensure a patent airway and maintain adequate oxygenation and ventilation.
  • Remove impaled objects in the face or throat only if they impair airway patency or breathing or if they interfere with your ability to effectively manage the airway. Otherwise, stabilize them in place and protect them from being jarred.
  • Never remove impaled objects from the eye; stabilize them in place and put a protective cone (such as a cup) over the object to prevent accidental movement along with bandaging the unaffected eye to prevent sympathetic movement.
  • Flush burns to the eye with copious amounts of sterile saline or sterile water. Never use chemical antidotes when treating burn injuries to the eye.
  • The primary threat from oral or dental trauma is oropharyngeal bleeding and aspiration of blood or broken teeth. Keep the airway clear, and ensure adequate oxygenation and ventilation. Endotracheal intubation may be required.
  • Any patient with head or face trauma should be suspected of having a spinal injury. Apply spinal motion restriction precautions as indicated.
  • The skull is a rigid, unyielding box that does not accommodate a swelling brain or accumulations of blood.
  • Normal ICP is 0 to 15 mm Hg in adults. Increased ICP can squeeze the brain against the interior of the skull and/or press it into sharp edges within the cranium. If severely increased ICP is not promptly treated, cerebral herniation will occur.
  • CPP is the pressure of blood flowing through the brain; it is the difference between the MAP and ICP.
  • If CPP drops below 60 mm Hg in the adult, cerebral ischemia will likely occur, resulting in permanent brain damage or death.
  • Begin treatment of a head-injured patient by stabilizing the cervical spine, opening the airway with the jaw-thrust maneuver, and assessing the ABCs.
  • All head-injured patients should receive 100% oxygen as soon as possible. If the patient is breathing adequately, apply a nonrebreathing mask set at 15 L/min. If the patient is breathing inadequately, assist ventilation and consider intubation.
  • Ventilate a brain-injured adult at a rate of 10 breaths/min. Avoid routine hyperventilation unless signs of cerebral herniation are present. Hyperventilation in a brain-injured adult is defined as a ventilation rate of 20 breaths/min.
  • Restrict IV fluids in a head-injured patient unless hypotension (systolic BP < 90 mm Hg) is present. Hypotension in a brain-injured patient should be treated with crystalloid fluid boluses in a quantity sufficient to maintain a systolic BP of at least 90 mm Hg.
  • Frequently monitor a head-injured patient’s level of consciousness, and document your findings. The GCS is an effective, reliable tool. The GCS must be repeated frequently if it is to be a reliable indicator of the patient’s clinical progression.
  • Intubation of a brain-injured patient may require pharmacologic adjuncts (such as sedation, neuromuscular-blocking drugs).
  • Seizures may occur in a brain-injured patient and can aggravate ICP and cause or worsen cerebral ischemia. Treat seizures with a benzodiazepine (such as diazepam, lorazepam).
  • A brain-injured patient’s survival depends on recognition of the injury, prompt and aggressive prehospital care, and rapid transport to a trauma center that has neurosurgical capabilities. Consider air transport if ground transport time will be prolonged.