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Traumatic brain injury (destination) — DIPIMC MCQ

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HardPre-Hospital TraumaTraumatic brain injury (destination)DIPIMCDipIMC

A 45-year-old has been assaulted and had an initial loss of consciousness. He is now GCS 8 (E2 V2 M4) with unequal pupils, the right being dilated. The heart rate is 50 and the blood pressure is 180/95. The nearest unit is a non-neurosurgical emergency department 6 minutes away; the neurosurgical major trauma centre is 30 minutes away.

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Correct answer: C — Pre-alert and transport directly to the neurosurgical major trauma centre.

A GCS of 8 with a unilateral dilated pupil and Cushing physiology indicates a likely expanding intracranial haematoma needing neurosurgery, so direct transfer to a neurosurgical centre is appropriate under NICE NG232 and trauma network arrangements. Delivering the patient to a non-neurosurgical unit introduces a delay to definitive care. Oxygenation is maintained and hypotension avoided en route.

Reference: NICE NG232 (Head injury)