Auckland District Health Board Home | Contact Us | Phone Directory | Search     
Auckland District Health Board  
part of menu  

Trauma Homepage
Up		 Navigation Bar Image
external link iconMinistry of Health
external link iconhttp://newzealand.govt.nz/

    horizontal line
 ©Copyright
 Published: 28/11/2011

Head Trauma

Head injury is common and is frequently one of several injuries. Head injury is a part of 'D', and as such A, B and C injuries take priority. Once initial stabilisation has been undertaken patients with GCS < 14 will require neurosurgical assessment including CT scanning at some stage Head Injury Algorithm.
Basic neurological examination should include assessment of the Glasgow Coma Scale noting not only the best response but also any lateralising signs (i.e. also the worst response). It should be remembered that hypoxaemia, shock, alcohol and other drugs all depress the level of consciousness and worsen the neurological signs. Analgesic and anaesthetic drugs and muscle relaxants also interfere with neurological assessment. 

Glasgow Coma Scale

  Response Score
Eye opening Spontaneous
To voice*
To pain
Nil		 4
3
2
1
Best verbal response Oriented
Confused**
Inappropriate
Incomprehensible
None 		5
4
3
2
1
Best motor response Obeying
Localizing
Withdrawal
Abnormal flexion
Extension
None 		6
5
4
3
2
1

* A patient with their eyes closed when not being spoken to is E 3.
** A patient who does not know the day of the week is V 4.

In general patients should go to the OR for haemostatic surgery prior to having CT scans of the head, although each case needs to be considered on its merits.

Last updated on 28/11/2011