Management of Traumatic Brain Injury

Prehospital Management

The patient requires immediate transport to a hospital with neurosurgical capabilities, with prehospital management focusing on airway protection, maintaining systolic blood pressure above 110 mmHg, and preventing secondary brain injury 1
Perform rapid neurological assessment using Glasgow Coma Scale (GCS), pupillary size/reactivity, and motor response to establish baseline 2, 3
Secure airway and provide supplemental oxygen to maintain SaO₂ > 95% to prevent hypoxemia, which is associated with poor neurological outcomes 2, 1
Establish IV access and maintain systolic blood pressure > 110 mmHg to ensure adequate cerebral perfusion 1
Control bleeding from occipital laceration with direct pressure and sterile dressing 4
Monitor vital signs and neurological status every 5 minutes until arrival at hospital 5

Continue neurological monitoring using complete GCS assessment and pupillary examination 2
Obtain non-contrast head CT scan without delay to identify potential intracranial injuries 1
Assess for signs of increased intracranial pressure (headache, nausea, blurry vision) 4, 6
Evaluate for signs of postconcussive syndrome using standardized assessment tools 4, 6

Perform complete head CT scan with inframillimetric sections to identify primary brain lesions 1
Consider CT-angiography if risk factors for vascular injury are present (occipital trauma) 1
Evaluate for retrograde and anterograde amnesia by asking about events before and after injury 4
Document all symptoms using a postconcussion symptom scale (headache, nausea, vomiting, balance problems, dizziness, visual problems) 4, 6
Monitor for signs of deterioration that may indicate need for neurosurgical intervention 6, 2

Provide analgesia for headache while monitoring for changes in neurological status 6
Administer antiemetics for nausea and vomiting 6
Maintain normocapnia if mechanical ventilation is required, as hypocapnia can cause cerebral vasoconstriction 1
Avoid hypotensive agents if sedation is needed 1
Consider external ventricular drainage if intracranial hypertension develops despite medical management 1

Admit for observation if CT scan shows intracranial injury or if symptoms persist despite normal imaging 7
If CT is normal but symptoms persist, consider observation for 24 hours to monitor for delayed deterioration 6, 7
Provide detailed discharge instructions written at sixth to seventh-grade level if discharged 6
Instruct patient to return immediately for worsening headache, repeated vomiting, increased sleepiness, confusion, or focal neurological deficits 6
Arrange follow-up to monitor for persistent postconcussive symptoms (headache, dizziness, visual problems, cognitive difficulties) 6

The reported 15-minute loss of consciousness is concerning and warrants thorough evaluation, as LOC occurs in less than 10% of concussions but may indicate more serious injury 4
The combination of blurry vision, headache, ataxia, and nausea following head trauma with LOC suggests possible intracranial injury requiring imaging 6, 7
Mental fogginess may predict slower recovery from concussion 4