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Second impact syndrome — MRCEM SBA MCQ

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HardConcussionSecond impact syndromeMRCEM SBA

A patient initially observed after head injury develops increasing drowsiness and a new unequal pupil. What is the next action?

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Correct answer: A — Resuscitate and obtain emergency CT and neurosurgical advice

The best answer is “Resuscitate and obtain emergency CT and neurosurgical advice”. Neurological deterioration and anisocoria indicate possible expanding intracranial haemorrhage or herniation. Immediate ABC management, urgent CT and neurosurgical discussion are required; treatment for raised intracranial pressure may be needed during transfer. Earlier reassuring findings do not protect against evolving bleeding.

Reference: NICE: Head injury—assessment and early management (NG232): https://www.nice.org.uk/guidance/ng232