Question:
I have a rather limited training wrt to head injury. As I understand it with a rise in ICP the pupil on the injured side will blow. blood pressure will drop, deterioration in level of response, slow, noisy breathing, slow full pulse, weakness or paralysis on one side of the body/face may develop, raised temp, hot flushed face etc.

Talking to a colleague he explained that there are four distinct stages involved. And in fact there may be a rise in BP before the drop. This may be "Cushing's Triad, or Cushing's response" but I really don't know

Answer: As you probaly already know, the treatment that can be provided in the prehospital setting is high flow oxygen delivered at a CONROLLED hyperventilation (26-30). Physiologically speaking, the increase in oxygen concentration will decrease the vasodilation of neural vasculature and tissue. Control the airway at all costs and elevate the head. Below this level there is too little blood flow, which increases swelling. Hyperventilation is the fastest way to treat cerebral edema and an increased intercranial pressure." This text goes on further to state the importance of early use of paralytics in the patient with a significant head injury, for fighting the tube elevates the ICP. It states initial use of succinylcholine with continued use of pancuronium. It is also noteworthy, in terms of treatment, that in the severe head injury, GCS <8, diazepam at doses of 10-20 mg may be needed to exit status epilepticus.

We are trying to track down national guidelines for head injury management for North America and European countries. We would be very grateful for any suggestions for where/ from which organisations we might be able to obtain information. We are looking for details on the use of skull xrays, use of ct scans, admission to hospital, referral to neurosurgery and transfer to neurosurgery. A Medline search and a followup on the retrieved references has not pinpointed national guidelines.