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Head/spinal injury

Assess conscious level and focal signs. Consider possibility of spinal injury. (X-ray skull and spine, CT scan).

Breathing

Administer oxygen and check respiratory movements are adequate; if not, ventilate.

Circulation

Check pulse and blood pressure. If patient is hypotensive, replace blood loss with plasma substitute followed by whole blood when available.

Limb injury

Examine limbs for lacerations and fractures. (X-ray.)

When intracranial haematoma is suspected, a CT scan is essential, especially before clinical signs are masked by a general anaesthetic required for the management of limb or abdominal injuries. However, if difficulty occurs in maintaining blood pressure, then urgent laparotomy or thoracotomy would take precedence over further investigation of a possible intracranial haematoma.

HEAD INJURY - ASSESSMENT

Some patients may describe the events leading to and following head injury, but often the doctor depends on descriptions from witnesses.

Points to determine:

Period of loss of consciousness: Relates to severity of diffuse brain damage and may range from a few seconds to several weeks.

Period of post-traumatic amnesia: This is the period of permanent amnesia occurring after head injury. It also reflects the severity of damage and in severe injuries may last several weeks. (Period of retrograde amnesia, i.e. amnesia for events before the injury is of less value since it bears no relation to the severity of injury and may improve with time).

Cause and circumstances of the injury: The patient may collapse, or crash his vehicle as a result of some preceding intracranial event, e.g. subarachnoid haemorrhage or epileptic seizure. The more 'violent' the injury, the greater the risk of associated extracranial injuries.

Presence of headache and vomiting: These are common symptoms after head injury. If they persist, the possibility of intracranial haematoma must be considered.

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