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This resource outlines crucial guidelines for the identification and management of head injuries, particularly focusing on the recognition of high-risk patients and significant signs. Given the tragic case of Natasha Richardson, it emphasizes the critical nature of assessing patients at risk for brain injury following mechanisms of injury such as falls from height and high-speed collisions. It discusses various assessment metrics including the Glasgow Coma Scale (GCS) and highlights symptoms like loss of consciousness, severe headaches, and post-traumatic amnesia that require immediate referral to appropriate medical facilities for further evaluation and intervention.
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Airway (with cervical spine control) Breathing Circulation Disability Environment/exposure
Head Injury Recognition of patients at risk
Head Injury Recognition of patients at risk A mechanism of injury suggesting a high energy injury:
Head Injury Recognition of patients at risk A mechanism of injury suggesting a high energy injury: fall from height (>5 stairs, >1m)
Head Injury Recognition of patients at risk A mechanism of injury suggesting a high energy injury: fall from height (>5 stairs, >1m) high speed collision (other skier, static object)
Head Injury Recognition of patients at risk A mechanism of injury suggesting a high energy injury: fall from height (>5 stairs, >1m) high speed collision (other skier, static object) possible penetrating brain injury
Head Injury Recognition of patients at risk Recognition of symptoms and signs
Adult patients with any of the following signs and symptoms should be referred to an appropriate hospital for further assessment of potential brain injury:
Adult patients with any of the following signs and symptoms should be referred to an appropriate hospital for further assessment of potential brain injury: GCS <15 at initial assessment (if the injury is thought to be alcohol related observe for two hours and refer if GCS score remains <15 after this time)
Alert Verbal Painful Unresponsive
Glasgow Coma Scale Feature Response Score Spontaneous 4 Eye opening (E) To speech 3 To pain 2 None 1 Verbal response (V) Orientated 5 Confused conversation 4 3 Words (inappropriate) Sounds (incomprehensible) 2 None 1 BEST motor response (M) Obeys commands 6 Localises pain 5 Normal flexion (withdrawal) 4 Abnormal flexion 3 Extension 2 None (flaccid) 1 Total Coma Score 3/15 - 15/15
Adult patients with any of the following signs and symptoms should be referred to an appropriate hospital for further assessment of potential brain injury: GCS <15 at initial assessment post-traumatic seizure (generalised or focal)
Adult patients with any of the following signs and symptoms should be referred to an appropriate hospital for further assessment of potential brain injury: GCS <15 at initial assessment post-traumatic seizure (generalised or focal) focal neurological signs
Adult patients with any of the following signs and symptoms should be referred to an appropriate hospital for further assessment of potential brain injury: GCS <15 at initial assessment post-traumatic seizure (generalised or focal) focal neurological signs signs of a skull fracture/penetrating brain injury (including cerebrospinal fluid from nose or ears, blood in the ear canal, boggy haematoma, post auricular or peri-orbital bruising)
Adult patients with any of the following signs and symptoms should be referred to an appropriate hospital for further assessment of potential brain injury: GCS <15 at initial assessment post-traumatic seizure (generalised or focal) focal neurological signs signs of a skull fracture loss of consciousness
Adult patients with any of the following signs and symptoms should be referred to an appropriate hospital for further assessment of potential brain injury: GCS <15 at initial assessment post-traumatic seizure (generalised or focal) focal neurological signs signs of a skull fracture loss of consciousness severe and persistent headache
Adult patients with any of the following signs and symptoms should be referred to an appropriate hospital for further assessment of potential brain injury: GCS <15 at initial assessment post-traumatic seizure (generalised or focal) focal neurological signs signs of a skull fracture loss of consciousness severe and persistent headache repeated vomiting (two or more occasions)
Adult patients with any of the following signs and symptoms should be referred to an appropriate hospital for further assessment of potential brain injury: GCS <15 at initial assessment post-traumatic seizure (generalised or focal) focal neurological signs signs of a skull fracture loss of consciousness severe and persistent headache repeated vomiting (two or more occasions) post-traumatic amnesia >5 minutes retrograde amnesia >30 minutes
Adult patients with any of the following signs and symptoms should be referred to an appropriate hospital for further assessment of potential brain injury: GCS <15 at initial assessment post-traumatic seizure (generalised or focal) focal neurological signs signs of a skull fracture loss of consciousness severe and persistent headache repeated vomiting (two or more occasions) post-traumatic amnesia >5 minutes retrograde amnesia >30 minutes Abnormal clotting (drug-induced, hypothermia etc.)
Head Injury Recognition of patients at risk Recognition of symptoms and signs Early investigation/intervention to prevent neurological deterioration
Geographical factors, for example where hospital attendance requires a prolonged journey, or special transport (by heli-copter or fixed wing aircraft), should not influence the referral of a patient with persisting impairment of consciousness, but in a patient who has not had impaired consciousness they may justify a higher threshold for referral.
