Major Head Injury – An Unusual Presentation

Author: David Leverton / Editor: Adrian Boyle / Reviewer: John Wilson, Ciaran Mackle / Codes: / Published: 16/10/2023

A 66-year-old male falls 6 feet from a step ladder on to concrete. On scene he is haemodynamically stable, his GCS is 15 and he is moving all 4 limbs.

On arrival to the local district general Emergency Department (ED) his primary survey is as follows:

A: patients own, triple immobilised C-spine

B: left sided chest wall bruising, sats: 95% on air, RR: 22, good a/e throughout

C: HR 98, regular. BP: 148/78

D: GCS 15/15, normal peripheral neurology all 4 limbs, right pupil: 3mm, sluggish to react to light left pupil: 2mm, brisk reaction to light BM: 4.8

E: Obvious lip and cheek lacerations, bruising and swelling over mid facial structures; no obvious long bone injuries; no actively bleeding wounds

Initial actions by ED team:

  • 15L o2 applied via non rebreather
  • Morphine analgesia titrated to pain
  • Trauma CT arranged

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