Management of head injuries

Abstract

T HE immediate treatment of a head injury should be directed towards the question of shock. BIankets and hot water bottIes are advised on admission to the hospita1. The head is Iowered. The patient is given an ampuIe of 746 grains of caffeine-sodio-benzoate, as this drug is a stimuIant for shock and has the added advantage in head injuries of reducing intracrania1 pressure. This drug shouId be continued every four hours unti1 signs of increased intracrania1 pressure cease or unIess contraindicated by undue restIessness of the patient. FIuids by vein or hypodermoclysis shouId not be used in treating shock as they predispose to earIy cerebra1 edema. Dehydration treatment is postponed unti1 shock is reIieved. Compound fractures shouId be disregarded, except for the appIication of tincture of iodine and a steriIe dressing, unti1 a11 evidences of shock have subsided. Fifty cubic centimeters of 30 per cent gIucose soIution are given intravenousIy as earIy as possibIe to treat the shock and Iater shouId be used as a part of the dehydration treatment. Morphine is a respiratory depressant. It is very seIdom indicated even in shock foIIowing the head injury or in the most restIess patient. It is best not used in these cases. dressing to scaIp wounds after suturing. Dressings annoy the restIess patient, are frequentIy puIIed off anyway, and if appIied tend onIy to macerate the wound. A steriIe towe pIaced on the piIIow is usuahy sufficient dressing to a cIosed scaIp wound. FrequentIy scaIp wounds are cIosed too tightIy. A few sutures to contro1 hemorrhage are usuaIIy a11 that is necessary even in a Iong Iaceration. Ears discharging bIood shouId never be irrigated. They shouId be kept steriIe by being swabbed out with an antiseptic. A piece of steriIe gauze shouId be carefuIIy pIaced in the externa1 cana and changed when saturated. Rest in bed for two weeks in the Iess severe cases with symptoms to a Ionger time in the more serious cases is a necessary measure in treating these patients. After the patient has reacted from shock the head shouId be elevated. The use of the ice bag to the head is advisabIe, especiaIIy in treating the patient’s reIatives and friends.