SU17.4-6 | Head Injury Assessment and Management — Summary & Reflection

KEY TAKEAWAYS

Head injury is graded by conscious level (mild/moderate/severe) and hinges on one distinction: primary injury at the moment of impact (contusion, diffuse axonal injury — irreversible) versus secondary injury afterwards (hypoxia, hypotension, raised ICP, ischaemia — preventable), which all management aims to avert. In the closed skull (Monro-Kellie), an expanding mass raises intracranial pressure. Know the haematomas: extradural (arterial, middle meningeal artery, biconvex on CT, lucid interval) and subdural (venous bridging veins, crescentic, common in elderly/anticoagulated), plus subarachnoid and intracerebral. Assess with the Glasgow Coma Scale — Eye/4, Verbal/5, Motor/6, total 15 (min 3); ≤8 = severe = intubate — repeated serially, with pupils and lateralising signs; recognise the Cushing reflex (hypertension + bradycardia + irregular respiration) of dangerously raised ICP. First-line imaging is NCCT head. Manage by ABCDE resuscitation first (avoid hypoxia/hypotension), then prevent secondary injury (head up 30°, treat fever/seizures, maintain perfusion), control ICP (mannitol/hypertonic saline), and perform urgent craniotomy and evacuation of a compressing haematoma, reassessing serially and referring early.

REFLECT

Picture yourself as the doctor who first saw the alert motorcyclist. Would you have resisted the temptation to discharge an awake, talking patient, and instead arranged serial GCS observation and a CT? Be honest about how easily a busy casualty can miss the slow build of an extradural bleed. Think about the Glasgow Coma Scale — could you score all three components correctly on a real patient under pressure, and would you record them as components rather than a bare number so that a colleague could detect deterioration? Reflect on the idea that the brain damage you can actually change is the secondary kind: which single habit — protecting the airway and blood pressure first, or insisting on repeated assessment — will you commit to so that, faced with a head injury, you genuinely save brain rather than merely observe it being lost?