Assess and Treat a Casualty with a Head Injury 

I. Head Trauma Assessment and Management: 
All head injuries are potentially dangerous for 2 primary reasons: 
a. Tissue damage and infection.
b. Loss of nerve function which regulates bodily systems. 
For these reasons, all signs and symptoms referable to the nervous system must 
be carefully noted including the time of their occurrence and observation. 
A. Primary Survey - after obtaining a history. 
1. ABC's w/ c-spine control 
a. With all head injuries, c-spine injury is suspected until proven otherwise.
b. Start one IV (RL) TKO.  If shock is suspected, insert another & treat for 
shock.
c. Start high-flow oxygen therapy ASAP. 
2. Perform a brief neurological examination - Recording the patient's LOC will 
greatly assist the physician who treats the patient later. One key question is 
whether the patient had lost consciousness at any time after the accident. Try 
to obtain: 
1. AVPU - to determine the state of consciousness for a baseline. 
Alert, responds to Verbal, or Painful stimuli, Unresponsive 
2. Pupilary Response - pupils evaluated for their equality and response to 
bright light. 
a. a difference in pupil diameter more than 1mm is abnormal. 
b. a sluggish response, or dilation of pupils to bright light may indicate an 
intracranial injury. 

PERRLA 
Pupils Equal Round Respond to Light and Accommodate (accommodate in conscious 
patient) 
3. Vital signs - changes in vital signs frequently indicate the onset of 
complications. 
Reassess every 5-10 minutes. (Temperature, pulse, blood pressure and 
respiration). 
Pulse and blood pressure are most important: 
a. rising BP w/ slow pulse indicates increased intracranial pressure (ICP)
b. falling BP w/ rapid pulse indicates shock
c. if patient is going into shock, then treat for shock first 
B. Secondary Survey: Inspect and treat each injury. 
1. Inspect the head - Stop external bleeding of the scalp, but not from ears or 
nose. 
a. Lacerations
b. Nose and ears for blood or other fluids 
2. Palpate the head 
a. Fractures
b. Lacerations for underlying fractures 
3. Inspect scalp lacerations - Inspect wound under direct vision only. Avoid 
blind probing w/ an instrument or the gloved finger. Never try to push in or 
remove any tissue or bone fragments. Look for the following: 
a. Brain tissue
b. Depressed skull fractures
c. Debris - remove hair or other types of debris excluding bone fragments.
d. Central spinal fluid (CSF) leaks 
4. Perform a minineurologic exam using AVPU. 
5. Palpate the c-spine for fractures and make sure that the c-spine is properly 
immobilized. 
6. Reassess the patient continuously, observing for signs of deterioration. 
7. Vitals/EVAC 
Training and Evaluation Outline 
CONDITIONS 
The casualty you are surveying has a head injury. All other injuries of a more 
serious nature have been treated. Necessary materials and equipment: field 
dressings, cravats, and intravenous (IV) setup. 
STANDARDS 
Identifies the presence of a head injury and does all the necessary to treat the 
head injury without causing additional injury to the casualty. 
TRAINING/EVALUATION 
Evaluation Preparation 
Setup: For training and evaluation have another soldier act as the casualty. Use 
a moulage kit or other material to simulate a head wound. To test step 1, coach 
the simulated casualty on how to answer the soldier's questions regarding such 
signs as headache. Tell the soldier what signs and symptoms the casualty is 
exhibiting. 
Brief soldier: Tell the medic to distinguish between injuries and do the steps 
to treat the injury. 
Evaluation Guide 
Performance measures                                                             
        Results 
1. Performs primary survey 
a. stabilizes patient using correct sequence of ABC                              
  P     F
b. starts one IV at TKO                                                          
              P     F
c. gives oxygen                                                                  
                   P     F 
2. Performs a minineurological exam                                              
             
a. AVPU                                                                          
                    P    F 
b. PERRLA                                                                        
                  P    F 
3. Obtains vital signs I                                                         
              P     F 
4. Performs secondary survey 
a. identifies underlying fractures                                               
              P     F
b. checks for fluid or blood escaping from nose or ears                          
P     F
c. does not apply pressure to or try to push brain tissue into head,          P  
  F
and does not remove bone                                                         
                     
d. does not give casualty anything to eat or drink                               
     P     F
e. applies a sterile dressing                                                    
                 P     F
f. evaluates patient's state of consciousness                                    
         P     F
g. palpates c-spine and ensures proper placement of c-collar                  P  
   F 
5. Obtains vital signs II                                                        
               P     F 
6. Recognizes and treats shock if present                                        
  P     F 
7. Records treatment and evacuates patient                                      
P     F 



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