Trauma Guideline Manual - SUNY Upstate Medical University

Trauma Guideline Manual______________Upstate Medical University Trauma Center107a) GCS ≤14.b) Any patient with focal neurologic deficit.c) Any patient with loss of consciousness or amnesia to the event.3. CT priorities:a) CT should be abandoned if patient requires emergent operation to stop hemorrhage orimmediately repair life-threatening injury. Notify neurosurgery immediately of thissituation.b) CT should be obtained, otherwise, to determine presence of space-occupying clot priorto other surgeries.4. Sedation:a) Uncooperative or thrashing patients should be treated with sedation.i) Morphine 0.1 mg/kg IV if associated with painful injury.ii) Midazolam 0.075 mg/kg IV for agitation or other benzodiazepine.iii) If intubated, Propofol 20 mcg/kg/min. Titrate to achieve adequate sedation.iv) If intubated, Pancuronium 0.1 mg/kg IV or vecuronium 0.1 mg/kg IV, if sedation is notsatisfactory, to allow ventilatory control or cooperation with the diagnostic studies. Donot give paralyzing agent without associated pain medications or sedative.5. Seizures:a) Administer lorazepam 2 mg IV (adults) repeatedly until seizure breaks.b) Prophylaxis with leviacetram ( Keppra) 1000mgi) Administer if seizure has occurred.ii) Administer if there is a high likelihood of post-traumatic seizure.a) Penetrating injury.b) Skull fracture with depression.c) Intraparenchymal hematoma.6. If there are localizing findings, high suspicion of a major TBI or a GCS