ABSTRACT
The level of pain associated with head trauma may be difficult to assess due to changes in normal behavior and mentation. A thorough physical examination including a neurological examination should be performed before any pharmacologic alteration of CNS activity occurs. Vital signs and neurological status should be closely monitored and appropriate supportive therapy initiated if necessary. The traumatic nature of these injuries precludes the use of preemptive analgesics. Mandibular and maxillary nerve blocks may be useful for fractures or injuries of the maxilla and mandible. If there is any indication of intracranial hypertension, respiration should be closely monitored before and after high doses of opioids or other drugs which may affect respiration are administered. Changes in respiratory rate or tidal volume alone are not enough to gauge respiratory depression. Use of arterial blood gas monitoring or capnometry will more accurately monitor changes in ventilation.
