Initial Management

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

2. Immobilize cervical spine in patients with known or suspected history of head injury.

3. Assess GCS; if < 8, perform endotracheal intubation.

4. Assess for signs of herniation (dilated nonreactive pupil, papilledema, posturing) or increased intracranial pressure (Cushing triad of hypertension, bradycardia, irregular respirations). If present, prevent hypercarbia and fever, maintain euv-olemia, consider administration of mannitol or normal saline, and obtain emergent CT scan of head and neurosurgical consultation.

5. Perform rapid bedside glucose determination. If glucose is < 40, administer IV dextrose.

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