patient presented to ED with head injury GCS-13/15. he was drowsy..
my question is should we wait for pupil to be unequal in size for taking C.T. head,will it make a delay in initiating treatment.....is size of pupil a major indicator for C.T.head...or is it the GCS.... which is important???
Usually a GCS of 13-15 indicates a mild head injury. The pupil size become unequal only in moderate to severe head injury. So, if the GCS was 13, the pupils are expected to be equal in size. Another thing you can look for is whether they are reacting to light or not. This is also a sign of head injury. If there was loss of consciousness then it is important to take a CT scan to rule out any TBI. Mode of injury, the impact on head etc are other useful features to assess head injury. Also, if there is a suspected neurological deficit then it is important to opt for CT. A drowsy patient should be monitored frequently until regains full consciousness. If condition deteriorates then an urgent CT can be requested. Hope this helps. Take care!
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