Uganda guidelines for the treatment of Head Injuries

Glasgow Coma Scale — Severe Head Injury

GCS 3–8. Features: altered level of consciousness, agitation, coma, seizures, focal neurological deficits, pupil abnormalities.

Glasgow Coma Scale — Moderate Head Injury

GCS 9–13.

Glasgow Coma Scale — Mild Head Injury (Concussion)

GCS >13. Transient short-lived loss of mental function: loss of consciousness <5 minutes, transient amnesia, headache, disorientation, dizziness, drowsiness, vomiting. Symptoms should improve by 4 hours after trauma.

Signs of Skull Base Fracture

Raccoon eyes (haematoma around eyes), bleeding or CSF leaking from nose or ears. Requires urgent referral.

GCS Scoring — Eye Opening

No response: 1. Open to pain: 2. Open to voice: 3. Open spontaneously: 4.

GCS Scoring — Verbal Response

No response: 1. Incomprehensible sounds: 2. Inappropriate words: 3. Disoriented but conversing: 4. Oriented and conversing: 5.

GCS Scoring — Motor Response

No response: 1. Extension to pain (decerebrate): 2. Abnormal flexion (decorticate): 3. Flexion/withdrawal from pain: 4. Localising pain: 5. Obeys commands: 6.

All Head Injuries — Primary Survey

Assess and maintain airway with cervical spine protection. Assess breathing and provide oxygen. Assess circulation and control haemorrhage. Assess disability (GCS, pupils).

Mild Head Injury (GCS >13)

Observe for 4–6 hours. Discharge if improvement and no risk factors. Advise to return if worsening headache, vomiting, confusion, or weakness develops. Provide written head injury advice.

Moderate Head Injury (GCS 9–13)

Admit for observation. IV access and fluids. Urgent CT scan if available. Neurosurgical referral.

Severe Head Injury (GCS ≤8)

Intubate to protect airway if GCS ≤8 or rapidly falling. Maintain SpO2 >95%. Avoid hypotension (target systolic BP >90 mmHg). Avoid hyperventilation. Give Mannitol 0.25–1 g/kg IV if signs of cerebral herniation. Urgent CT scan and neurosurgical referral.

Seizure Management

Give Diazepam 5–10 mg IV (adult) or 0.3 mg/kg IV (child). Consider phenytoin 15–20 mg/kg IV for seizure prophylaxis in severe head injury.

Avoid in Head Injuries

Morphine and pethidine (cause respiratory depression). Excessive IV fluids (worsen cerebral oedema). Glucose solutions (worsen cerebral oedema).