Head injury
A streamlined, differential-led presentation for rapid clinical review.
Twenty-second review
- Head injury can cause scalp bleeding, skull fracture, cerebral contusion, diffuse axonal injury, or intracranial hemorrhage with evolving pressure and perfusion effects.
- Declining GCS, repeated vomiting, focal deficit, seizure, unequal pupils, anticoagulation, or signs of skull fracture requires urgent transport.
- Keep intoxication in the differential; overlapping or concurrent illness remains possible.
- For head injury, trends and combinations of findings are more informative than one isolated vital sign.
Compare the clinical patterns
The repeated material is grouped inside each possibility. Open only the condition you need.
Intracranial hemorrhageTime-sensitive high-risk possibility
HPI
Clarify mechanism; loc; amnesia.
Signs & symptoms
Worsening headache, vomiting, focal deficit, seizure, anticoagulation, or decreasing consciousness.
Focused exam
Expose only as needed, inspect and palpate systematically, and document distal circulation, sensation, and movement; Reassess pain, swelling, perfusion, and neurologic status after movement or intervention.
Brief pathophysiology
Intracranial hemorrhage may cause head injury through a time-sensitive process capable of rapid physiological deterioration.
What the trend may show
Hemorrhage is a trend diagnosis: tachycardia and narrowing pulse pressure may precede hypotension. Age, pregnancy, medications, and pacing can blunt expected responses.
Heart rate (bpm)
Often risesTachycardia is a common compensatory response but may be absent.
Pulse pressure (mmHg)
May narrowNarrowing pulse pressure can reflect reduced stroke volume.
Blood pressure (mmHg)
May fall lateA normal pressure does not exclude significant compensated hemorrhage.
MAP (mmHg)
May fallA falling trend supports worsening perfusion; interpret with mental status and skin signs.
Front-load in the triage report
- Intracranial hemorrhage: Worsening headache, vomiting, focal deficit, seizure, anticoagulation, or decreasing consciousness.
- Mechanism.
- LOC?
ConcussionCommon presentation pattern
HPI
Clarify mechanism; loc; amnesia.
Signs & symptoms
Brief symptoms with stable neurologic examination may occur after lower-energy trauma.
Focused exam
Expose only as needed, inspect and palpate systematically, and document distal circulation, sensation, and movement; Reassess pain, swelling, perfusion, and neurologic status after movement or intervention.
Brief pathophysiology
Concussion may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.
What the trend may show
Isolated injury may have normal observations. Serial heart rate, pressure, respiratory status, and oxygenation help identify occult hemorrhage or thoracic injury.
Heart rate (bpm)
May risePain, distress, and hemorrhage can increase rate; medications can blunt it.
Blood pressure (mmHg)
May fall lateA normal pressure does not exclude compensated hemorrhage.
Respiratory rate (breaths/min)
Trend rate / effortTachypnea may reflect pain, thoracic injury, shock, or acidosis.
Oxygen saturation (SpO₂)
Usually preservedLow saturation suggests thoracic injury, hypoventilation, or concurrent disease.
Front-load in the triage report
- Brief symptoms with stable neurologic examination may occur after lower-energy trauma.
- Mechanism.
- LOC?
Scalp injuryCommon presentation pattern
HPI
Clarify loc; amnesia; initial/current gcs.
Signs & symptoms
Brief symptoms with stable neurologic examination may occur after lower-energy trauma.
Focused exam
Reassess pain, swelling, perfusion, and neurologic status after movement or intervention; Trend E/V/M, pupils, focal neurology, scalp and facial injury, cervical findings, vomiting, and anticoagulant use.
Brief pathophysiology
Scalp injury may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.
What the trend may show
Isolated injury may have normal observations. Serial heart rate, pressure, respiratory status, and oxygenation help identify occult hemorrhage or thoracic injury.
Heart rate (bpm)
May risePain, distress, and hemorrhage can increase rate; medications can blunt it.
Blood pressure (mmHg)
May fall lateA normal pressure does not exclude compensated hemorrhage.
Respiratory rate (breaths/min)
Trend rate / effortTachypnea may reflect pain, thoracic injury, shock, or acidosis.
Oxygen saturation (SpO₂)
Usually preservedLow saturation suggests thoracic injury, hypoventilation, or concurrent disease.
Front-load in the triage report
- Brief symptoms with stable neurologic examination may occur after lower-energy trauma.
- LOC?
- Amnesia?
IntoxicationImportant alternative presentation
HPI
Clarify mechanism; loc; amnesia.
Signs & symptoms
May obscure or mimic neurologic change and never excludes injury.
Focused exam
Expose only as needed, inspect and palpate systematically, and document distal circulation, sensation, and movement; Reassess pain, swelling, perfusion, and neurologic status after movement or intervention.
Brief pathophysiology
Intoxication can resemble head injury through overlapping symptoms or referred physiology despite a different primary mechanism.
What the trend may show
Isolated injury may have normal observations. Serial heart rate, pressure, respiratory status, and oxygenation help identify occult hemorrhage or thoracic injury.
Heart rate (bpm)
May risePain, distress, and hemorrhage can increase rate; medications can blunt it.
Blood pressure (mmHg)
May fall lateA normal pressure does not exclude compensated hemorrhage.
Respiratory rate (breaths/min)
Trend rate / effortTachypnea may reflect pain, thoracic injury, shock, or acidosis.
Oxygen saturation (SpO₂)
Usually preservedLow saturation suggests thoracic injury, hypoventilation, or concurrent disease.
Front-load in the triage report
- May obscure or mimic neurologic change and never excludes injury.
- Mechanism.
- LOC?
Findings that should escalate concern
- Declining GCS, repeated vomiting, focal deficit, seizure, unequal pupils, anticoagulation, or signs of skull fracture requires urgent transport.
- Intracranial hemorrhage: Worsening headache, vomiting, focal deficit, seizure, anticoagulation, or decreasing consciousness.
Medication recognition
Continue the clinical pathway
Clinical and academic sources
Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.
BCEHS Handbook — specific CPGs
Supporting clinical and academic evidence
- CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians
Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.
- Major trauma: assessment and initial managementNational Institute for Health and Care Excellence
Evidence-based initial assessment, hemorrhage control, imaging, and trauma-system guidance.
- Guidelines for the Management of Severe Traumatic Brain Injury, Fourth EditionNeurosurgery · 2017
Prevention of secondary brain injury and evidence-based severe traumatic brain injury care.