Anaesthetists Handbook - MEDICAL EDUCATION at University ...

Miscellaneous issuesMost delays occur during preparation for transfer – whether interdepartmentalor inter-hospital – and must be avoided.Extracts from the GuidelineThe maximum allowable time from injury to removal of intracranialhaematoma must not exceed four hours. Delays in the managementof intracranial haematoma are either disabling or fatal.Assessment and clarificationResuscitation and assessment is the first priority and should involvethe Airway, Breathing, Circulation approach (ABC) as described inAdvanced Trauma Life Support (ATLS). The airway should bemanaged by the most experienced clinically trained person(Anaesthetist / Intensivist / ED Consultant), supported by a suitablytrained assistant.Ventilated patientsIf the patient requires intubation and ventilation then an anaesthetistshould be contacted to undertake this procedure; suitably trainedemergency room staff may intubate if an anaesthetist cannot bepresent immediately.Indications for intubation and ventilation after head injury• Coma - not obeying commands, not speaking not eye opening(i.e. GCS ≤ 8).• Loss of protective laryngeal reflexes.• Abnormal ventilation.• Hypoxaemia (PaO2 < 13 kPa on oxygen) SpO2 < 94%.• Hypercarbia (PaCO2 > 6 kPa).• Hypocarbia (causing PaCO2 < 3.5 kPa).• Respiratory arrhythmia.• Possible aspiration.• Continuing seizures.210 Anaesthetists Handbook January 2010