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Head injury (Complications (Deteriorating GCS Once resus appropriately,…

- - - - GCS
        Repeated scores essential
        Min 3, max 15
        Unconciousness when >8 (needs ITU and intubation)
      - Eyes
        Pupil size (mm) and reaction to light
        Eye movements
        Check fundi (papilloedema, haemorrhages)
      - Glucose
        Check BM, provide glucose if needed
    - - Head
        Full cranial nerve and cerebellar examination
        Examine face and head injuries
        Signs of base of skull fracture: bilateral orbital bruising
        (panda eyes), subconunctival haemorrhage, haemotypanum
        or bleeding from EAM, CSF otorrhoea/rhinorrhoea, bruising
        over mastoid process (Battle sign)
      - Limbs
        Full neurological examination
        Orthopaedic examination
      - Abdomen
        Check for abdominal injuries
        FAST scan, CT
  - - - Analgesia
        IV morphine
      - Abx
        Indication: if compound skull fracture
        E.g. cefuroxime IV
      - Tetanus immunisation
      - Siezure management
        IV lorazepam, IV phenytoin
        Intubation and IPPV if needed
      - Treat high ICP
        E.g. IV mannitol
        MOA: osmotic diuresis
    - - Decompressive craniotomy
        Indication: persistent rised ICP
- - - - CT head
        
        Interpretation
        Skull fracture
        Intracranial haematoma (midline shift, extradural or subdural)
        Contusions (areas of low/mixed attenuation)
        Cerebral swelling (small ventricles)
        
        Indications
        
        CT <1h
        GCS <13 at any point or <14 2h post injury
        Dangerous mechanism of injury
        Suspected open or depressed skull fracture
        Suspected basal skull fracture
        Post-trauma seizure
        Focal neurological deficit
        1+ episode vomiting (except children <12y)
        
        CT <8h
        Amnesia >30min of events pre-injury
        LOC +/or amnesia if age >65y, coagulopathy, dangerous MOA
        
        Rationaile
        Identify and define type of brain injury
        Most requested <1h, some <8h
      - Head X-ray
        
        Rationaile
        Views AP, lateral and Townes (AP axial)
        Good for fractures but not intracranial lesions
        
        Indications
        Only in adults with minor injury not needing immediate CT scan
        Rarely used
      - Others
        FAST scan/abdo CT: if associated abdominal injury suspected
        Limb X-rays: if associated bony/soft tissue injuries