Assessment

Look, Listen and Feel for

• Skull deformity

• Unequal or poorly reactive pupils

• Blood or fluid from ear or nose

• Movement and sensation in all 4 limbs

• Blood glucose check always in the confused or unconscious patient

• Assess AVPU or Glasgow Coma Scale, GCS

• Assess for Confusion, lethargy or agitation

• Convulsions

Management

• If GCS<9 (or for children AVPU score of P or U), plan for advanced airway support
• If patient is lethargic or unconscious, re-assess the airway frequently
• Suspect spine injury or closed head injury with any trauma patient with altered mental status
• Give oxygen
• If low blood glucose or unable to check, give glucose
• If convulsing, give a benzodiazepine like diazepam

Examples of Conditions: 

1. Severe Head Injury

Signs:

• Visual changes, memory loss, convulsions, vomiting, headache
• Altered mental status 
• Scalp wound 
• Skull deformity
• Bruising to head 
• Blood or fluid from the ears or nose
• Unequal pupils indicating possible increased intracranial pressure

Management: spinal immobilization, use log-roll precautions, assess changes in level of consciousness using GCS, antibiotic cover for open skull fracture, Nil per Os until, elevate head of the bed to 30 degrees if suspected increased intracranial pressure, Neurosurgeon's review.