Serious (unconscious) Head Injuries: When and how to evaluate the
abdomen?
If the patient with a serious head injury, GCS<8, is
haemodynamically stable and has been since the injury, then the priority lies with the
head injury management.
Scenario 1 - Stable Patient
The patient should have an urgent head CT and then, if there is no space occupying
lesion, have an abdominal CT in the one session. Please remember, in general, if there is
an intracranial haematoma on CT that requires drainage, do not proceed with abdominal
CT. Instead, while the patient is being prepared for craniotomy in theatre, a DPL can be
rapidly performed.
Scenario 2 - Unstable or Borderline patient
In general a DPL in the resuscitation room provides the quickest answer to the question of
whether a patient needs a laparotomy. It is important that a potentially unstable patient
with a serious head injury does not become hypotensive as this significantly worsens the
outlook, increasing mortality by 30%.
We are using F.A.S.T (Ultrasound) increasingly in
place of DPL in Trauma Care.
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