Initial Imaging and Diagnostic Workup for Suspected Traumatic Brain Bleed

Immediate Diagnostic Orders

The American College of Surgeons recommends ordering an urgent non-contrast head CT scan immediately for any patient with suspected traumatic brain injury, as this is the definitive diagnostic test and should not be delayed 1
Non-contrast head CT scan is the mandatory first-line imaging study for all patients with suspected traumatic brain hemorrhage, according to the Critical Care society 2, 3, 1
Haemodynamically stable patients with suspected head bleeding following high-energy injuries should undergo CT assessment, as recommended by the Critical Care society 2, 3, 4
The Critical Care society advises against relying on clinical characteristics alone to determine whether symptoms are due to ischemia or hemorrhage, and recommends that neuroimaging is mandatory 1

A coagulation panel, including PT/INR and aPTT, should be assessed to evaluate for coagulopathy, as recommended by the Critical Care society [5, [ignore ref]]
The Praxis Medical Insights society recommends obtaining a complete blood count with hemoglobin and platelet count 6
Serum lactate should be measured to estimate and monitor the extent of bleeding and shock, according to the Critical Care society 2, 3, 7, 4
Base deficit should be measured to estimate and monitor the extent of bleeding and shock, as recommended by the Critical Care society 2, 3, 7, 4
Blood products should be type and crossmatched in preparation for potential transfusion, as advised by the Critical Care society 8

The World Journal of Emergency Surgery and Praxis Medical Insights societies recommend performing an urgent neurological evaluation, including pupillary assessment and Glasgow Coma Scale (GCS) motor score 9, 1
The mechanism of injury should be documented, as this represents an important screening tool to identify patients at risk for significant traumatic hemorrhage, according to the Critical Care society 8

The Critical Care society recommends maintaining mean arterial pressure ≥80 mmHg in patients with combined hemorrhagic shock and severe traumatic brain injury 5
The Praxis Medical Insights society advises maintaining systolic blood pressure >100 mmHg during initial interventions 1, 6
For isolated TBI without hemorrhagic shock, different blood pressure targets may apply, but cerebral perfusion must be prioritized, as recommended by the Critical Care society 5

The Critical Care society recommends employing FAST (Focused Assessment with Sonography for Trauma) for detection of free fluid in patients with suspected torso trauma 2, 3, 4
Patients with significant free intraabdominal fluid and hemodynamic instability should undergo urgent surgery, as advised by the Critical Care society 2, 3, 4

The Praxis Medical Insights society advises against delaying CT imaging to obtain laboratory results if the patient is stable enough for transport to the scanner 1
The Critical Care society recommends avoiding hyperventilation unless there are signs of imminent cerebral herniation, as routine hyperventilation worsens outcomes in TBI patients 8
Hypotonic solutions, such as Ringer's lactate, should not be used in patients with severe head trauma, as recommended by the Critical Care society 5
The Praxis Medical Insights society advises against hypotension and hypoxia, which worsen secondary brain injury 1

The World Journal of Emergency Surgery and Praxis Medical Insights societies recommend obtaining urgent neurosurgical consultation for all salvageable patients with life-threatening brain lesions identified on CT 9, 1
Neurosurgical consultation should occur immediately after CT confirms intracranial hemorrhage, not delayed for additional workup, as advised by the World Journal of Emergency Surgery society 9