🚨 Head Injury

Head injury encompasses any trauma to the head, ranging from minor scalp lacerations to severe brain damage. It's a common presentation in emergency departments, requiring rapid assessment to identify life-threatening intracranial pathology.

History of trauma (fall, assault, RTA), headache, nausea/vomiting, altered consciousness (GCS drop), focal neurological deficits, seizures. Look for signs of skull fracture (Battle's sign, Raccoon eyes, CSF rhinorrhoea/otorrhoea). Always consider mechanism of injury and patient comorbidities.

Immediate ABCDE assessment is paramount. Secure airway, ensure adequate breathing and circulation, and assess neurological status using GCS. Expose to check for other injuries and signs of trauma.

Decreasing GCS score, new focal neurological deficit, pupillary asymmetry, persistent vomiting, seizures, signs of skull fracture, worsening headache. These indicate potential intracranial haemorrhage or rising ICP and require urgent intervention.

Bedside: GCS, pupil assessment, vital signs. Bloods: FBC, U&Es, coagulation screen, group and save. Imaging: CT head (non-contrast) is the gold standard for acute head injury to rule out intracranial haemorrhage or fracture. Cervical spine imaging may also be required.

Maintain airway and oxygenation, ensure adequate ventilation. Control bleeding from scalp wounds. Maintain normotension and normoglycaemia. Administer antiemetics for vomiting. Consider analgesia. Elevate head of bed to 30 degrees if ICP is suspected.

Any GCS drop, new focal neurology, pupillary changes, or suspected intracranial haemorrhage on CT head. Discuss all moderate to severe head injuries with a neurosurgical registrar immediately. Patients requiring intubation or with unstable vital signs need critical care input.

Remember the 'red flag' symptoms for CT head imaging as per NICE guidelines. A GCS of 8 or less often indicates severe head injury requiring intubation. Always consider non-accidental injury in children. Epidural haematomas are typically arterial and rapidly expanding, often presenting with a lucid interval.