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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

Examination:

  • 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

Notes:

  • 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)

Reference:

  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

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