Urgent CT head imaging is indicated. His history satisfies multiple criteria within both on the NICE CT head selection criteria and Canadian Head CT rule. This should be within 1 hour.
If cervical spine stability cannot be discounted clinically, CT cervical spine should be also performed. Supplementary contrast-enhanced CT polytrauma imaging should be considered.
Recreational drug use is a distinct possibility. An ECG and serial troponins can help diagnose a cocaine-induced acute coronary syndrome. An admission urinary toxicology can be diagnostically helpful.
