Head Injury: Secondary/Tertiary Level Facilities

Initial assessment of head injury patients as they arrive in the EC

Further management of the head injury patient

Initial assessment of head injury patients as they arrive in the Emergency Centre

Further management of the head injury patient

DISCUSS WITH THE NEUROSURGEON IF:

• Surgically significant abnormality on imaging (e.g. contusion, tract haematoma, depressed skull fracture, extra-axial haematoma, intracerebral haematoma or brain swelling).
• Regardless of imaging:
  • Persisting coma after initial resuscitation.
  • Unexplained confusion which persists for more than 4 hours
  • Deterioration in GCS after admission
  • Progressive focal neurological signs
  • A seizure without full recovery
  • Suspected penetrating skull injury
  • A cerebrospinal fluid leak

IF THE PATIENT RECEIVED SEDATION:

Observe in the recovery setting.