Head Injury Scenario (ECA)

On arrival, family members are taking turns performing CPR. What should be your first priority?

You ask the family to stop CPR while you confirm cardiac arrest. The patient appears to be breathing slowly. What features may be present in agonal breathing that help differentiate it from slow but effective breathing?

You confirm a respiratory rate of approximately 12 and the patient has a carotid pulse, so CPR is stopped. The family report they do not know how far the patient fell, but they heard banging and then found him unconscious at the bottom of the stairs with major bleeding from the back of his head. The patient remains unconscious and is making snorting noises on inspiration. What airway manoeuvre would be most appropriate in this scenario?

You perform a jaw thrust to relieve the snorting noise, remaining mindful of a potential spinal injury. Your colleague returns with their advanced airway kit and take over airway management. What should be your next priority?

You perform a rapid trauma primary survey to identify any other significant injuries, and find none so far — it appears to be an isolated head injury. Your colleague is struggling to establish an advanced airway as the patient is agitated. They note the patient opens eyes to pain, makes incomprehensible sounds, and withdraws from pain. What is their GCS?

Your colleague asks for oxygen as the patient is too agitated to tolerate an advanced airway, so they insert an OPA which appears to be effective. As far as you are aware, the patient has sustained an isolated traumatic head injury. Does this still meet criteria for major trauma requiring high-flow oxygen?

You hand over a non-rebreather mask. Once applied, the Paramedic asks you to take the head so they can gain IV access. The patient becomes increasingly agitated and you are finding it harder to maintain manual in-line stabilisation. What should be your approach?

Another crew arrives to assist, and they advise an Enhanced/Critical Care Team is approximately 3 minutes behind them. Your initial observations are: HR 92, RR 12, BP 105/54, SpO2 100% on 15 L/min O2, Temp 36.9°C, and BM 4.2. What is the significance of Cushing’s triad?

If your patient was showing signs of Cushing’s triad, what would you expect to see?

Your patient is not currently showing signs of Cushing’s triad, but remains agitated with a GCS of 8. The Paramedic has achieved IV access. What drugs might they consider in this patient?

The Critical Care Team arrives and suggests they would like to prepare RSI for the patient. What are the benefits of RSI, explaining why it has been recommended so soon after arrival?

What is the overall aim of pre-hospital treatment for a patient with TBI?

Secondary brain injury refers to…

What temperature range should severe TBI patients be maintained within to improve recovery, according to the latest evidence?

If available, end tidal CO2 should be monitored in all severe TBI patients, as maintaining normocapnia has been shown to significantly improve outcomes.