Neobook — clinical reference

Management of the head injury patient in district level facilities
Preparing the patient for transfer to a secondary or tertiary level facility
Further management of patients who are not referred

Management of the head injury patient in district level facilities

Preparing the patient for transfer to a secondary or tertiary level facility

The referring professional should determine if an ambulance is required based on the patient’s condition.
Telephonically notify the receiving Emergency Centre physician.
A letter summarising all the symptoms and signs should be sent with the patient.
Transportation should be undertaken within 4 hours.
Monitor at regular intervals before and after transport: GCS, pupil size and reactivity, RR, HR, BP, O₂ sats

In all circumstances complete initial resuscitation and stabilisation of patients, and monitor at regular intervals to avoid complications during transport

Further management of patients who are not referred

Discharge patient if:

Normal examination
Normal observations
No indication for transfer

Discharge into care of competent adult

Provide written and verbal instructions: refer to page 19.

If patient returns to the Emergency Centre within 48 hours of discharge with persistent complaints relating to the initial head injury such as:

Drowsiness
Confusion, agitation, abnormal behaviour
Severe headache
Vomiting
Seizures
Neurological signs or symptoms such as limb weakness or paraesthesia

Involve a senior clinician and refer for CT scan.