Page 25 - PJ MED OPS Handbook 8th Ed

Mild TBI
Dx:
1. “Bell rung”, “saw stars”, “stunned”, loss of consciousness <30 minutes, memory loss around
event
Rx:
1. Perform GCS, neuro exam and MACE
2. Rest for 72 hours

Basilar Skull Fracture (Skull Base Fracture)
Dx:
1. Raccoon eyes
2. Battle’s sign
3. CSF rhinorrhea or otorrhea (clear fluid from the nose or ears)
Rx:
1. None
2. Document GCS
3. Transport to neurosurgeon

NOTE: If PFC setting observe for cranial nerve injury and meningitis.

Oro-pharyngeal Hemorrhage
Dx:
1. Massive, uncontrolled bleeding coming from the mouth or throat in a casualty with neck or facial
trauma
Rx:
1. Procedural IV sedation (ketamine 100mg) and local lidocaine if responding to pain and time,
tactics and clinical condition permit
2. Cricothyroidotomy
3. Pack the oropharynx with combat gauze – leave a tail for each roll outside the mouth
Indications for intubation

1. Unable to maintain airway – altered consciousness, gurgling, etc.
2. Desaturation despite simple efforts and clinical deterioration – requires judgment in tactical and
austere settings
3. Respiratory rates >30 and <10
4. GCS <8 (unconscious TBI patients)

NOTE: Use RSI if the gag reflex is still intact and the patient requires intubation
In the uncontrolled environment if you can use means not requiring intubation, ventilator
or ambu-bag and maintain adequate O2 saturation, then monitor the patient closely but be
ready to intervene.

Chapter 4. PJ Medical and Trauma Protocols (MTPs) n 23