Initial Workup for Trauma Patient with Scooter Accident and Alcohol Abuse History

Primary Assessment

The American College of Emergency Physicians recommends assessing airway, breathing, circulation, and disability (ABCD) as per standard trauma protocols 1
Determine Glasgow Coma Scale (GCS) score - even patients with GCS 15 require neuroimaging if they have risk factors, as recommended by the American College of Emergency Physicians 2
Check for signs of intoxication - alcohol intoxication is a significant risk factor for positive CT findings, according to the American College of Emergency Physicians 2, 3
Evaluate for physical evidence of trauma above the clavicle - this is a strong predictor of intracranial injury, as noted by the American College of Emergency Physicians 2

Head CT is indicated in patients with a history of alcohol abuse, facial trauma, or mechanism of injury (scooter accident), due to multiple high-risk factors, as recommended by the American College of Emergency Physicians 2

Alcohol intoxication is a risk factor requiring head CT, according to the American College of Emergency Physicians 2, 3
Physical evidence of trauma above the clavicle is a predictor of intracranial injury, as noted by the American College of Emergency Physicians 2
Headache or vomiting are risk factors requiring head CT, as recommended by the American College of Emergency Physicians 2
Age >60 years is a risk factor requiring head CT, according to the American College of Emergency Physicians 2
Deficits in short-term memory are a risk factor requiring head CT, as noted by the American College of Emergency Physicians 2
Seizure is a risk factor requiring head CT, as recommended by the American College of Emergency Physicians 2

Complete blood count is recommended to assess for anemia or thrombocytopenia, as suggested by the American College of Emergency Physicians 1
Basic metabolic panel is recommended to evaluate electrolyte abnormalities, according to the American College of Emergency Physicians 1

Even with a normal initial CT scan, patients with alcohol intoxication require extended observation, as recommended by the American College of Emergency Physicians 2, 4
Serial neurological examinations are essential, as deterioration can occur within the first 24 hours, according to the American College of Emergency Physicians 4

Relying solely on GCS score is a common pitfall - patients with GCS 15 can still have significant intracranial injuries, especially when alcohol is involved, as noted by the American College of Emergency Physicians 2, 3
Discharging intoxicated patients too early is a common pitfall - alcohol can mask deterioration, according to the American College of Emergency Physicians 2

Neurosurgical consultation is recommended for any positive findings on head CT, as suggested by the American College of Emergency Physicians 1