Regional Emergency Medical Advisory Committee of New York City
Prehospital Advanced Life Support Protocols
Copyright January 1996 (8/96)

521 HEAD INJURIES

In patients with head trauma who have a Glasgow Coma score of 13 or lower:

  1. Begin Basic Life Support Head and Spine Injuries procedures.
  2. Begin Cardiac Monitoring, record and evaluate EKG strip.
  3. Begin an IV infusion of Normal Saline (0.9 NS) to keep vein open, or a Saline Lock.
  4. Perform Endotracheal Intubation in patients with a Glasgow Coma Scale score of less than 8.

    NOTE: ADMINISTER LIDOCAINE 1.5 MG/KG, IV/SALINE LOCK BOLUS, IMMEDIATELY PRIOR TO INTUBATION TO MINIMIZE THE INCREASE IN INTRACRANIAL PRESSURE. (MAXIMUM DOSE IS 1.5 mg/kg.)
  5. If a seizure is witnessed, contact Medical Control for implementation of one or more of the following MEDICAL CONTROL OPTIONS:

MEDICAL CONTROL OPTIONS:

OPTION A:

Administer Diazepam 5.0-10 mg, IV/Saline Lock bolus. Repeat doses of Diazepam 5.0-10 mg, IV/Saline Lock bolus, may be given if seizure activity persists or recurs. (Rate of administration may not exceed 5.0 mg/min)
OR
Lorazepam 2.0-4.0 mg, IV/Saline Lock or IM. Repeat doses of Lorazepam 2.0-4.0 mg, IV/Saline Lock, or IM, may be given every 5 minutes, if seizure activity persists or recurs. (Maximum total dosage is 8.0 mg.)
OPTION B:Transportation decision.

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