Sun14November1246PM 13

A 70-year-old woman is admitted to Emergency department following a road traffic accident 3 hours ago.

She is maintaining her own airway with a respiratory rate of 18 breaths per minute and SpO2 on air is 97%. Her heart rate is 85 beats per minute and her blood pressure is 140/70 mmHg. She has a visible bruise over the right temporal region and a Glasgow coma score (GCS) of 14. There are no other apparent injuries.

She has a past medical history of hypertension and atrial fibrillation, her normal medications include atenolol and warfarin. She does not recall the accident. A radiology service is available on site but the nearest neurosurgical unit is 40 miles away.

What is the next appropriate management option?

(Please select 1 option)

Electively intubate and ventilate the patient for transfer to the neurosurgical unit for further management

Request CT scan within the next hour Correct

Admit to the Emergency department ward for neurological observations

Request CT scan within the next eight hours

Transfer to the neurosurgical unit for neurological observations

Explanation

The National Institute for Health and Care Excellence (NICE) guidelines on head injury published in 2007 recommend that patients with known coagulopathy or on treatment with warfarin should have imaging by CT with results analysed within one hour of request.

Other criteria for CT within the one hour include:

GCS <13 when first assessed in Emergency department

GCS <15 when assessed in Emergency department two hours after the injury

Suspected open or depressed skull fracture

Sign of fracture at skull base (haemotympanum, "panda" eyes, cerebrospinal fluid leakage from ears or nose, Battle's sign)

Post-traumatic seizure

Focal neurological deficit

1 episode of vomiting.

Reference:

NICE. Head injury (CG176).

Answer Statistics

1

2%

2

87%

3

3%

4

8%

5

3%

Times answered: 307