Moderate Closed Head Injury GCS 9 to

Children with moderate closed head injury should be observed in an intensive-care unit (ICU) setting with hourly neurological checks. NPO status should be maintained for the first 12 to 18 hours and isotonic intravenous (IV) fluids should be administered at a maintenance rate. A neurosurgeon or critical-care physician should repeat a complete neurological examination 6 hours after admission. Serum sodium and glucose should be measured upon admission and again 6 to 12 hours later. If there is doubt about the child's respiratory status or ability to guard their airway, the neurosurgeon and critical care team, in collaboration, should decide whether to sedate and intubate the patient. If the child has a GCS of 15 and a normal neurological examination within 18 to 24 hours, they may be transferred to a regular ward without any further imaging and given a regular diet. Patients with an abnormal GCS or neurological examination after this time period should remain in the ICU and undergo repeat imaging.

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