Head Injury management in primary care

Rapid assessment to identify if 999 emergency

Administer life saving support until transfer

Glasgow Coma Scale - if score less than 15

Neck pain or tenderness

Paraesthesia in extremities

Cervical immobilsation for suspected cervical spine injury

History

Mechanism of injury

RTA?

Diving accident?

Fall from height?

How and when it occured

Symptoms

Consciousness, confusion, amnesia, seizure, vomiting, headache, neck pain, visual disturbacnce or diplopia

Recent alcohol or drug intake

Anti-coagulation meds?

PMH including pre-injury function, bleeding disorders, previous head trauma, surgery.

Examine

Leakage from ear of ?CSF, blood, haematoma, periorbital haematoma

Cranial nerves - fundoscopy, balance/walking ability, Paraesthesia, loss of muscle power.

Signs of trauma to head, neck

Neck tenderness? - possible cervical spine injury

Awareness of non accidental injury

GCS, vital signs and signs of hypoxia/shock?

Self-harm, domestic violence, child maltreatment

Follow up

Mild head injury

If symptomatic of vomiting, worsening headache or new neuro symptoms - REFER URGENTLY