Greetings from Scotland

2. Greetings from Scotland

3. Head Injury

4. Natasha Richardson 1963 - 2009

5. Airway (with cervical spine control) Breathing Circulation Disability Environment/exposure

6. S I G N

7. Head Injury Recognition of patients at risk

9. Head Injury Recognition of patients at risk A mechanism of injury suggesting a high energy injury:

10. Head Injury Recognition of patients at risk A mechanism of injury suggesting a high energy injury: fall from height (>5 stairs, >1m)

11. 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)

12. 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

13. Head Injury Recognition of patients at risk Recognition of symptoms and signs

14. Adult patients with any of the following signs and symptoms should be referred to an appropriate hospital for further assessment of potential brain injury:

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 (if the injury is thought to be alcohol related observe for two hours and refer if GCS score remains <15 after this time)

16. Alert Verbal Painful Unresponsive

17. 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

18. 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)

19. 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

20. 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)

21. 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

22. 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

23. 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)

24. 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

25. 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.)

26. Head Injury Recognition of patients at risk Recognition of symptoms and signs Early investigation/intervention to prevent neurological deterioration

28. 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.

30. Tack så mycket

31. Thank you