HEAD AND NECK INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 104

thespinalcord.Similarly,anindividual whohassustained anisolated braininjurydoesnot
have motor impairment of the extremities. Thus, shock or paralysis should never be attrib-
uted to brain injury and warrant the search for associated injuries to the torso and spine.

Treatment
No specific treatment for brain injury is possible in the field. The therapy of choice for
severely braininjured individuals is intensive care in conjunction with neurosurgical inter-
vention.Theidealtreatmentforanypersonwhohassustainedapotentiallysignificanthead
injury in the wilderness is airway protection and immediate evacuation to a trauma center
with neurosurgical capabilities. Since brain injuries tend to be underappreciated, the de-
cision for evacuation should be made generously in the field. The algorithm in Table 8-2
lists the symptoms and risk factors that warrant early evacuation of any individual who has
sustained head trauma in the wilderness.
Treatment for specific injuries includes the following:
External bleeding from scalp wounds should be controlled by direct pressure over a
sterile dressing.
Open skull fractures should never be probed, and foreign bodies embedded into the
skull or brain must not be removed. These injuries must be covered with a sterile
dressing. Antibiotic treatment should be started early with amoxicillin/clavulanate
(Augmentin®) or trimethoprim/sulfamethoxazole (Bactrim or Septra®).

Table 8-2 Evaluating Head Trauma in the Wilderness

Level of consciousness
A Normal, fully awake, alert, oriented, GCS 15, A VPU
B Minimally impaired, awake, disoriented, GCS 14, A V PU
C Impaired, somnolent, disoriented, GCS 13 or less, AV P U
C Comotose, GSC 8 or less, AVP U
Presentation
B Amnesia (retro-/anterograde)
C Abnormal pupils (symmetry, reaction)
C Skull fracture (direct or indirect signs)
B Severe headache
B Nausea, vomiting
Trauma mechanism
A Minor

B Fall from height greater than 20 feet (6 m)