421

HEAD AND SPINE INJURIES

1. Establish and maintain airway control while stabilizing the cervical spine.
   
   DO NOT USE A NASOPHARYNGEAL AIRWAY IN PATIENTS WITH FACIAL INJURIES OR IF SEVERE HEAD INJURY HAS OCCURRED.
2. Utilize the Rapid Takedown technique if the patient is standing.
3. Administer oxygen.
4. Monitor breathing for adequacy.

MONITOR BREATHING CONTINUOUSLY. BE ALERT FOR SIGNS OF HYPOXIA AND/OR INCREASING RESPIRATORY DISTRESS.

1. Control external bleeding.
2. Immobilize the patient's head and spine with a rigid collar and appropriate immobilization device.
3. Assess and monitor the Glasgow Coma Score. (See Appendix E.)

• If the Glasgow Coma Scale (GCS) score is less than 8, ventilate the patient with high concentration oxygen at a rate of 12 breaths per minute for an adult patient, and up to 20 breaths per minute for a pediatric patient.
• If the Glasgow Coma Scale (GCS) score is less than 8, and active seizures or one or more of the following signs of brain herniation are present, hyperventilate the patient with high concentration oxygen at a rate of 20 breaths per minute for an adult patient and up to 25 breaths per minute for a pediatric patient.

• Fixed or asymmetric pupils
• Abnormal flexion or extension (neurologic posturing)
• Hypertension and bradycardia (Cushing’s Reflex)
• Intermittent apnea (periodic breathing)
• Further decrease in GCS score of 2 or more points (neurologic deterioration)

DO NOT HYPERVENTILATE UNLESS THE ABOVE CRITERIA ARE MET.

4. Assess for shock and treat, if appropriate. (See Protocol #415.)

5. Transport. (See Appendix F.)