Case of the Month #39 Traumatic Brain Injury

Published 25/05/2023

What investigations would you prioritise?

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.