Community/Dispensary level Interventions

• Clean and dress any wound
• If unconscious, ensure airway is patent
• Keep patient warm
• Put in coma position
• Prevent spinal injury by stabilizing the neck with neck collar
• Refer to the centres/health facilities where there is expertise

Health Centre Interventions

• Take full history from patient, relatives or whoever has brought patient where indicated, follow the ABCDE trauma protocol
• Ensure adequate oxygenation by mask or ETT
• Surgical debridement and suture wound as appropriate
• Record and monitor vital signs including pupil size and symmetry
• Give IV line Normal saline or Ringer’s lactate (do not give dextrose infusion!)
• Catheterize
• Refer if moderate or severe TBI, seizure or pupil asymmetry.

Hospital Level Interventions

• History as above, follow the ABCDE trauma protocol
• Examine patient thoroughly, note the level of consciousness, pupils’ asymmetry and any lateralizing signs
• Treat seizures by:

o Diazepam inj. 10mg 8 hourly
o Phenobarbitone inj. 100mg 8 hourly
o Phenytoin inj 100mg 8 hourly

• Brain CT scan if GCS score is 9 or below (absolute indication), GCS 10–14 relative indication for CT scan Admit to ICU if GCS score is 8 and below, or refer if required
• Craniotomy is indicated for specialist cases e.g. intracranial hematomas, depressed skull fractures based on pupil asymmetry, lateralizing signs and brain CT scan
• Refer orConsult the specialist if indicated especially moderate and severe traumatic brain injury, pupil asymmetry is noted or evidence in brain CT scan