3 Head Injuries
Learn how to establish and reassess neurologic status after a head injury, recognize deterioration, and prioritize airway, circulation, spinal precautions, and urgent escalation.
Establishing a neurologic
Establish a structured neurologic after a suspected head injury so that later findings can be compared with the patient's initial condition. Assess and document level of consciousness, components and total, pupil size and reaction, speech, and limb movement.
Repeat assessments as indicated by the patient's condition and local protocol. Document the components as well as the total score; a single score does not replace serial assessment.
Recognizing and escalating deterioration
Compare each reassessment with the . A decrease in GCS, increasing confusion, or other worsening level of consciousness is an urgent change. Notify the responsible clinician or activate the emergency response promptly while reassessing , breathing, circulation, and neurologic status. Do not delay action until unequal pupils or another more dramatic sign appears.
Report the full neurologic picture, including GCS components, pupil findings, vital signs, and the timing of changes.
Recognizing
After a head injury, repeated vomiting, worsening headache, unequal pupils, confusion, unusual behavior, seizures, weakness, and difficulty waking are that can signal worsening brain injury. Arrange immediate emergency evaluation and report the findings. Mild tiredness that is unchanged is distinct from difficulty waking.
Prioritizing immediate threats
Prioritize , breathing, and circulation. If a patient with head trauma cannot maintain an open , support the and ventilation immediately, summon qualified assistance, and maintain spinal precautions. A patient with severe TBI who cannot protect the needs urgent management by qualified clinicians.
Assess oxygenation and blood pressure, and avoid hypoxemia and hypotension, which can worsen secondary brain injury. Maintain when injury is possible. A full secondary survey, oral medication, food, fluids, or placing the patient in a chair must not delay immediate support.
Applying the priorities
A change from the patient's is critical. Reassess systematically, protect and oxygenation, avoid hypotension, maintain spinal precautions when indicated, and promptly escalate worsening consciousness, pupil findings, speech, movement, or other .