Head injuryRefer

• Paracetamol IV, Ondansetron, Mannitol 20% (raised ICP / herniation), Levetiracetam (severe TBI, 7 d), Td (scalp wound)

• CT head now: GCS below 13 at first or below 15 at 2 h, open or depressed fracture, signs of basal fracture, seizure, vomiting more than once, focal deficit, or on anticoagulant (NICE NG232 2023)

First visit

• GCS and pupils — Record on arrival and repeat.
• Blood glucose — Drowsy patient.

Only if indicated

• CT head — GCS under 13 on arrival or under 15 at 2 h, open or depressed fracture, basal skull fracture signs, seizure, vomiting more than once, focal deficit, amnesia, or on anticoagulants.
• CT cervical spine — Neck pain, focal signs, or dangerous mechanism.
• PT/INR — On warfarin.
• X-ray chest, pelvis and FAST — Multiple injuries.

Follow-up and monitoring

• GCS every 30 min until 15 — Then hourly; any fall needs urgent CT.