A 90 year-old patient is brought in as a level-1 trauma. She had an unwitnessed fall, struck her head, and now she is unresponsive. On exam, vitals are HR 86, RR 14, BP 182 / 94, T 98.0, RA sat 100. She is unresponsive without spontaneous movements. There is a small hematoma to the back of her head. How do we proceed? What is the dx? What should we do first?
Airway first, but while getting ready to intubate, someone check pupils, glucose, and DNR/DNI status – maybe it’s just a mechanical fall with intracranial bleed, but maybe she’s out because she overdosed on opiates (though her RR is too normal, if it’s real) or is hypoglycemic.