Other aspects of medical care of head injuries

Seek expert advice.

Nutrition must be continued with due reference to any fasting for surgery. About 2000-3000 KCal/day should be provided through a nasogastric tube.

General nursing is essential - frequent turning is necessary to prevent bed sores; the eyelids should be taped to prevent damage to the cornea; the limbs should be passively exercised to prevent the development of contractures; pain may be relieved by codeine phosphate.

"Stress ulceration" may result in the development of gastrointestinal bleeding

• there is a lack of concensus regarding pharmacological management to prevent 'stress ulceration'
  • H2 antagonists such as cimetidine or ranitidine are often prescribed but they seldom prevent ulceration, presumably because of the role of mechanisms other than gastric acidity in these circumstances.
  • proton pump inhibitors and sucralfate have been used

Pyrexia is common. Frequently, it is the result of infection, either intracranially, in the chest or in the urinary tract. It may persist in the absence of infection, presumably, as a result of damage to the hypothalamus. In such cases, fans should be used to cool the patient, and chlorpromazine may be useful.

Seizures occur in about 5% of patients and are a powerful predictor of post-traumatic epilepsy. They can usually be controlled with phenytoin.