BVNS Neurotransmitter 2.0 Technically Speaking April 2020

Bush Veterinary Neurology Service is proud to publish the Neurotransmitter 2.0 Technically Speaking; a newsletter written by our technicians for technicians.

Nursing Care of a Head Trauma Patient
Katie Pinner,  LVT (BVNS Richmond)


Introduction

Head trauma, a common presentation in veterinary medicine, can be stressful and scary for clinicians and technicians. However, vigilant nursing care can lead to improved outcomes. Common presentations of head trauma include patients who have been hit by cars, blunt force trauma, or the common big dog versus little dog altercation.

The two classes of injury include primary source of injury, which cannot be changed quickly, followed by a secondary source of injury. Though similar to spinal cord injuries head trauma is complicated by the confined space of the skull which can lead to increases in intracranial pressure (ICP).

Acute Trauma

Patients are initially assessed for any acute trauma with a focus on airway, breathing, and circulation to address any immediate life-threatening conditions. Hypotension and hypoxemia should be addressed as soon as possible with oxygen supplementation and fluid resuscitation therapy. Sneezing should be avoided as it can increase ICP thus avoiding nasal cannulas is ideal.

Pain Control

Pain control is also essential in the head trauma patient. Pure mu agonists are ideal for these patients and can be titrated to effect.  This class of drugs can be completely reversed with naloxone in the event of adverse effects such as bradycardia or decreased respiratory rate.  Hypertension is commonly seen with head trauma due to the increase in intracranial pressure.  It is important to remember that hypertension could also be a pain response. Anticonvulsant therapy is also essential if the patient is experiencing seizures. Benzodiazepines, phenobarbital, or levetiracetam can all be useful in these cases.  Corticosteroids are not indicated as a first-line drug in head trauma patients as studies have shown them to be associated with poor outcomes and increased infection risk.

Fractures and Wounds 

Once stable, the head trauma patient should be assessed for fractures and wounds.  The modified Glasgow coma scoring system should be utilized as a tool to assess prognosis and repeated every 60-90 minutes as treatment continues.  Increases in intracranial pressure can be minimized by elevating the cranial end of the patient at a 30-degree angle (pictured above).  Care should be taken not to kink the neck or occlude any cervical vasculature as this can lead to increases in intracranial pressure as well. Normovolemia should be maintained in order to maintain adequate cerebral perfusion.

Hypertonic saline (4ml/kg) or mannitol administered over 15-20 minutes can be used to as osmotic diuretics to reduce intracranial pressure after normovolemia is achieved. Once stable, advanced imaging and possible surgical intervention if warranted can be considered. The most important aspects of nursing care to remember are as follows:

Key Takeaways

  1. Keep the cranial end of the body elevated at about a 30-degree angle
  2. Keep the patient clean and dry with adequate bedding rotating every 4 hours
  3. Keep eyes lubricated to avoid corneal ulceration
  4. Maintain adequate oxygenation and pain control
  5. Express bladder and ensure adequate urine production
  6. Use vigilant monitoring by keeping a close eye on blood pressure, body temperature, level of awareness, pupillary light response, and hydration status

Caring for the head trauma patient can ultimately be very rewarding. Careful monitoring and nursing care are paramount to successful outcomes in this patient population.

 

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References

  1. BSAVA Manual of Canine and Feline Neurology, 4th Edition.