Travel Reference
In-Depth Information
A major risk factor that may aggravate traumatic brain injury is taking blood thinner
medications, such as aspirin, new-generation platelet inhibitors such as clopidrogel
(Plavix®) or long-term anticoagulants such as warfarin (Coumadin®). In addition, age is
an important risk factor for developing a severe brain injury due to the fragility of cereb-
ral vessels in older persons, which increases the risk of significant bleeding in the injured
brain, even after minor trauma.
Incontrasttothefrequentbluntheadinjuriesresultingfromfalls,individualsmayrarely
sustain penetrating brain injuries in the wilderness. Such injuries may result from, for ex-
ample, accidental gunshot wounds, penetration of falling sharp objects, or falls from a
height onto an edged rock. Any penetrating head trauma must be considered a severe brain
injury, even in the absence of a loss of consciousness or other risk factors.
The following parameters must be immediately assessed in an individual who has sus-
tained a head injury:
Airway compromise
Alertness, awareness, and orientation
Amnesia
Injuries to the scalp and skull
Cerebrospinal fluid or blood seeping from ears or nose
Pupil size, symmetry, and reactivity
History and mechanism of trauma
Risk for aggravation of brain injury
Significant associated injuries
Severe headache
Nausea and vomiting
Airway Compromise
Theprincipalriskforindividualswhohavesustainedheadinjuriesisacuteairwaycom-
promise, which must be recognized and alleviated immediately. Anoxia or hypoxia caused
byairwayobstructionafteraheadinjuryleadstotheworstoutcomesandmayresultinirre-
versible cognitive and functional impairment. Airway management has the highest priority
for any person with a suspected brain injury ( Chapter 3: Life-Threatening Problems ) . As a
rule of thumb, an individual who is fully awake, alert, and able to communicate verbally
without any signs of distress does not have a compromised airway.
Amnesia and Level of Consciousness
Nextinpriorityisevaluatingthelevelofconsciousness,awareness,andorientation.The
level of consciousness is judged by asking the individual specific questions related to the
accident(“Whathappened?”)andinquiringaboutcurrenttime,place,andpersonalinform-
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