Head Injuries

If in Doubt, Seek Neurological Advice

HISTORY
• Mode and Time of injury.
• Initial GCS.
• Duration of loss of consciousness.
• Any obvious neurological signs at the time.
• Trend in GCS since then.
• Background illnesses and medications or drugs,
especially alcohol

EXAMINATION
• Assess Glasgow Coma Score.
• Assess limb strength for asymmetry
• Assess pupillary size, asymmetry or lack of
pupillary reaction.
• Injury to the scalp, skull, neck, face including cuts,
abrasions or bruising and including CSF leakage
from ear or nose.
 PROTOCOLS FOR THE MANAGEMENT OF
HEAD INJURIES

This protocol is designed for use with the general protocol

for management of trauma patients (and presumes that it
has been followed in relation to airway and haemodynamic
management). It presumes a brisk clinical examination
and appropriate history. If operation is required for other
reasons, head injury management may become more
difficult.
Consult the duty neurosurgeon.

A. GCS 8 OR LESS :
Action: Call Neurosurgeon.
• Sedate, paralyse and intubate patient
• Ventilate (PCO2 about 30 mm Hg)
• Mannitol 20% lg/kg IVI stat
• Emergency CT scan as soon as possible.
• Peritoneal lavage all patients in this category.

B. GCS 9 -14 WITH FOCAL SIGNS :

Action: Call Neurosurgeon.
• Half hourly neuro observations.
• If decreased GCS go to A above.
• Urgent CT scan within 2 hours.
C. GCS 9 -14 WITHOUT FOCAL SIGNS BUT FRACTURE
ON SKULL X-RAY :
Action:
• Half hourly neuro observation for 6 hours.
• If decreased GCS develops, or focal signs, go to A above.
• If GCS stable at 6 hours, hourly observation for 12
hours, then 4th hourly for 8 hours.
• At 24 hours if GCS 15 and if home environment
supervised, discharge with head injury card.

D. GCS 9 -14 WITHOUT FOCAL SIGNS, NO FRACTURE

ON SKULL X-RAY :
Action:
• Half hourly neuro observation for 6 hours If decreased
GCS develops, or develops focal signs, go to A above.
• If GCS 15 at 6 hours and home environment supervised,
discharge with head injury card.

E. GCS 15 ON ARRIVAL, NO FOCAL NEUROLOGICAL

SIGNS AND NO SKULL FRACTURE ON X-RAY :
Action:

• Observe half hourly for 4 hours and discharge home with

head injury card.