Head Injury (Responder) Scenario

What tool can you use to get a first impression of a paediatric patient? 

The patient looks out of place and dazed. No increased work of breathing and no abnormalities to their appearance such as mottling. What should be your first assessment priority in the DRCABC model?

The patient is responding with inappropriate words so unable to answer questions. He looks like he is struggling to keep his eyes open but opens his eyes and seems to refocus slightly each time you speak to him. There is no significant bleeding. Airway is open and patent. Breathing seems normal. The patient has a good complexion. You ask for the patient’s wrist which he gives, and you find a good, regular radial pulse. You see a graze to his head and a large crack to his helmet. What is the patients GCS?

Another bystander states they have called 999 and an ambulance should be with you soon. Should c-spine immobilisation be considered in this patient?

A patient with the possibility of spinal injury and a reduced GCS, when should manual inline stabilisation commence?

You start looking at manual inline stabilisation (MILS). The patient seems calm but still a bit dazed so you would like to help and keep movement to the spine as minimal as possible. The patient still has the helmet on. Can you get a bystander to help take the helmet off while you maintain MILS or should you leave the helmet on? 

As you take the helmet off you can see a large swelling to the patient’s apex of their head. There is bleeding but not much so you can see the injury site well. When presented with a head injury, what additional points should you consider, or additional examinations should you complete?

The patient was reported with brief loss of consciousness after injury by bystanders. Is this a red flag for concern in head injury patients?

The ambulance crew arrive shortly after you conduct MILS. What handover tool can you use for a precise quick handover for trauma patients?

The ambulance crew quickly set to work, recognising the potential for red flags in this patient. They administer appropriate pain relief and immobilise the patient using a vacuum mattress for spinal protection. The patient is now more comfortable and has a GCS of 14 following the head injury. 

Is TXA indicated within the JRCALC for a head injury with a GCS of 14? 

They are also adamant that they get an accurate blood pressure, and a good assessment of the patients pulse and respirations. When related to head injury, what do these three measurements constitute to?

Is Cushing’s reflex an early or late sign?

What other signs and symptoms may you witness before Cushing’s reflex that may indicate raised intracranial pressure?

What red flags indicate further assessment is required at ED according to NICE guidelines?

Within major trauma guidelines, high flow O2 should be given to all major trauma patients?