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Traumatic brain injury with lateralising signs — DipIMC MCQ

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HardTraumaTraumatic brain injury with lateralising signsDipIMC

A 36-year-old cyclist has struck a kerb at speed. He has GCS 8, unequal pupils, systolic blood pressure 148 mmHg, SpO2 96% after airway manoeuvres, and the nearest trauma unit is 8 minutes away while the major trauma centre with neurosurgery is 28 minutes away. What is the most appropriate transport decision?

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Correct answer: E — Pre-alert and convey directly to the major trauma centre if airway can be maintained

Severe head injury with lateralising signs needs a destination capable of definitive neurotrauma care when safe to bypass. A nearer unit may be appropriate if airway or physiology cannot be sustained, but this patient is oxygenating after simple airway manoeuvres. Hypoxia and hypotension are key preventable secondary insults.

Reference: NICE NG40 Major trauma service delivery; JRCALC Guidelines