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2499 pages added, reviewed or updated during the last month (last updated: 18/4/2021)

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immediate management in primary care

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History from patient, parent or witness - note:

  • loss of consciousness
  • amnesia
  • any neurological symptoms


  • site of injury, level of consciousness, pupils and co-ordination
  • reassures patient or parents of no significant injury
  • examination may not be needed to make clinical decision

Give head injury advice.

In significant injury:

  • do not move patient until neck is properly stabilised
    • patients who have sustained a head injury and present with any of the following risk factors should have full cervical spine immobilisation attempted unless other factors prevent this:
      • GCS less than 15 on initial assessment by the healthcare professional
      • neck pain or tenderness
      • focal neurological deficit
      • paraesthesia in the extremities
      • any other clinical suspicion of cervical spine injury
    • cervical spine immobilisation should be maintained until full risk assessment including clinical assessment (and imaging if deemed necessary) indicates it is safe to remove the immobilisation device
  • maintain airway
  • attend to other significant injuries
  • pain should be managed effectively because it can lead to a rise in intracranial pressure (1). Reassurance and splintage of limb fractures are helpful; catheterisation of a full bladder will reduce irritability
    • with respect to emergency department assessment
      • significant pain should be treated with small doses of intravenous opioids titrated against clinical response and baseline cardiorespiratory measurements (1)
  • make baseline record for A/E staff: history of injury, symptoms, pulse, BP, level of consciousness(description), pupils, limb co-ordination and any observed changes


  • standby calls to the destination emergency department should be made for all patients with a GCS less than or equal to 8, to ensure appropriately experienced professionals are available for their treatment and to prepare for imaging (1)


  1. NICE (September 2007). Head injury guideline.
  2. NICE (January 2014). Triage, assessment, investigation and early management of head injury in infants, children and adults

Last reviewed 01/2018