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Suspected cervical spine injury — DIPIMC MCQ

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HardPre-Hospital TraumaSuspected cervical spine injuryDIPIMCDipIMC

A head-injured patient initially scored GCS 14 and now scores 12 during transport, with no sedative administered. What is the most important interpretation?

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Correct answer: C — Reassess ABCs and neurology, then escalate airway and pre-alert plans

The best answer is “Reassess ABCs and neurology, then escalate airway and pre-alert plans”. A falling GCS after head injury is neurological deterioration until proved otherwise. Reassess ABCs, glucose, pupils and the separate GCS components, consider evolving intracranial injury and escalate the receiving pre-alert and airway plan without delaying transport. Trends are more informative than an isolated hospital value, and absence of pupillary asymmetry does not exclude important intracranial deterioration.

Reference: NICE NG232, Head injury: https://www.nice.org.uk/guidance/ng232/chapter/recommendations