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Sun Dec 17 15:58:54 GMT 2006

Dr. What did the tox screen show just by chance?

>From: "Stefan Mark Mazur" <stefmazur at ausdoctors.net>
>Reply-To: "Trauma &amp; Critical Care mailing list" 
><trauma-list at trauma.org>
>To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
>Subject: Re: Highly Irritable Head Injury Patient Date: Sun, 17 Dec 2006 
>01:18:01 +0000
>
>Navin,
>Without knowing the full clinical details it can be difficult to make 
>suggestions, but here goes.
>You need to consider possible causes of his irritability;
>Fear, pain, hpoxia, cerebral hypoperfusion from hypovolaemia, cerebral 
>irritation from intracranial pathology, intoxication, etc,etc,
>however given that you state he has a visible head injury you have to 
>assume that this is the cause of his irritation until proven otherwise.
>In order to properly assess and manage this patient you will need to have 
>"control" of him.  Assemble a team of at least 6 people (one for each limb, 
>one for the head and one to obtain IV access and give medications).  
>Attempt to constantly verbally explain and reassure the patient as to what 
>is occuring although this is likely to be unhelpful if irritability due to 
>head injury.  Make sure your team understands what they have to do and how, 
>and then physically restrain the patient, obtain IV access and give 
>sedation.  In nearly all head injuried patients to maintain adequate 
>"control" of both patient and airway and to ensure adequate cerebral 
>oxygenation whilst performing examination, investigation (i.e. CT head) and 
>management (i.e. control of external haemorrhage, correction of hypotension 
>etc) the patient will need to be intubated at this point.  This requires an 
>appropriate rapid sequence induction technique that won't drop cerebral 
>perfusion pressure or conversally, cause significant rises in ICP with 
>laryngoscopy.  There will be many different opinions in this trauma group 
>as to how to do this, but it will depend on the drugs you have available 
>and the familiarity with those drugs by the staff using them and performing 
>the intubation.  Last time I looked the Trauma.org website had a nice guide 
>to RSI and pros and cons of various meds that could be considered.
>Once airway is protected, depending on presence or absence of other 
>injuries, he can have a CT scan of his head to exclude a surgically 
>correctable cause of his irritability.
>This is a not infrequent problem in Emergency Departments I work in, 
>particularly on Friday/Saturday evenings.
>Hope this is helpful,
>Cheers,
>Stefan
>
>Dr Stefan Mazur
>Emergency Physician/Retrieval Fellow
>Adelaide
>Australia
>
>
>
>  On Fri, 15 Dec 2006 13:03:57 +0000 (GMT)
>  navin goyal <drnavingoyal at yahoo.co.in> wrote:
>>Dear Mail Subscribers,
>>
>>Had anyone  came  accross  a highly  irritable  Head Injury  Patient in 
>>the trauma resuscitation room with visble injury over the head . The 
>>patient does not allow you to take a IV access and using IV sedative is 
>>distant thing . And anything you do , you want to do as earlt as possible 
>>as you see a bleeding wound in the scalp .How did  you go about  this  
>>patient.
>>
>>Thank You
>>
>>Dr. Navin Goyal
>>Trauma Fellow
>>LTM Govt Hospital and medical College,
>>Sion , Mumbai.
>>INDIA.
>>
>>
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Highly Irritable Head Injury Patient