Initial Management

1. Support ABCs. Secure airway, administer 100% oxygen, and obtain IV access.

2. Immobilize cervical spine for known history of or suspected head trauma.

3. Assess GCS and perform endotracheal intubation if < 8.

4. Assess for signs of herniation (dilated nonreactive pupil, papilledema, posturing) or increased intracranial pressure (Cushing triad). If present, provide controlled mild hyperventilation, consider administration of mannitol or normal saline, and obtain emergent CT scan of the head and neurosurgical consultation.

5. Perform rapid bedside glucose determination; if glucose < 40, administer IV dextrose.

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