Head Injury
Surgical Emergencies 247(i) Splinting reduces pain, making handling easier; it also reduces
blood loss and the risk of neurovascular injury.5 Obtain urgent vascular and orthopaedic consults if distal ischaemia is
present. Otherwise refer the patient when the other major injuries have been
stabilized.
6 Traumatic amputation of a limb or digit
(i) Control haemorrhage by direct pressure and elevation of the
stump.
(ii) Consider the possibility of replantation, especially in a clean,
sliced wound without crushing
(a) preserve the amputated part by wrapping in a saline-soaked
sterile dressing
(b) seal the wrapped part in a sterile dry plastic bag, and immerse
in a container of crushed ice and water
(c) give i.v. antibiotics and tetanus prophylaxis as for a
compound fracture
(d) X-ray the limb and severed part
(e) refer the patient to the orthopaedic or plastic surgery team
for consideration of microvascular surgery ideally performed
within 6 h of injury.
HEAD INJURY
The diagnosis and management of head injuries is best considered in two groups:
● Severe head injury – see page 29, Section I, Critical Care.
● Conscious head injury.
Conscious head injury
The aim is to differentiate patients requiring admission from those who could be
allowed home.
DIAGNOSIS1 History
Enquire about:
(i) The nature and speed of impact.
(ii) Subsequent loss of consciousness, drowsiness, vomiting or
seizures.
(iii) The length of post-traumatic amnesia (PTA) from the time of
injury to the time of the return of memory for consecutive events.
This is often underestimated
(a) >10 min PTA is significant.