2 hour observation at clinic,

Mild (GCS 14 - 15) Improve --- follow up on site

Worst --- arrange for medevac

Anamnesa (if possible) Arrange medevac, ABC management,

Moderate (GCS 9 - 13)
Defined Severity & GCS score Anticipation for other symptoms.

Arrange medevac, ABC management,

Severe (GCS 3 - 8)
Control other symptoms.

Keep the airway open, remove foreign material, position gently &
avoid moving cervical spine, intubate if ventilation inadequate or
cricothyrotomy if intubation is not possible
90-100 % Oxygen 10-15 L/min, should be delivered by non-
rebreathing mask/resuscitator.

Stop external hemorrhage & insert large bore IV cannule, treat

shock/hypotension with rapid infusion of normal saline/RL. If BP is
normal avoid giving excess fluids (especially 5% Dextrose)

1. SYSTEMIC HYPERTENSION, DO NOT give antihypertensive medication,

treat by reducing intracranial pressure (cerebral edema).
2. CEREBRAL EDEMA, treat with:
- Hyperventilation, with endotracheal airway (PO2 > 80, PCO2 25-30 mmHg).
- Osmotic Diuretics (manitol) 20%, 1g/kgBW bolus (contraindicated for
patient with hypotension).
PS: Corticosteroids, ineffective for posttraumatic edema should not be given.

3. SEIZURES, Valium 5-10 mg over 1-2 min IV bolus, should not be repeated, can
be followed with a loading dose of Phenytoin 15-18 mg/kg IV rate 50 mg/min.
4. TETANUS PROPHYLAXIS, 0,5 ml IM TT or Hyper-Tet.
5. PROPHYLACTIC ANTIBIOTICS, for open cranial wounds give Cefotaxime
(Claforan) 1 g IV.
6. ANALGETICS, if necessary (Toradol, Pethidin or Morphin).
PS: analgetics should not be given unless pain caused by associated injuries.

Adapt from ATLS course and Current Emergency Diagnostis & Treatment