What is a good screening test for evaluation of closed head injury? What cases require overnight observation? How do I know which patients to send to the emergency department (ED)? — Beverly Greenfield, BSN,Great Barrington, Mass.

The standard neurologic assessment is still the best test. Pay specific attention to focal neurologic changes (e.g., pupil reactivity and equality), gait, level of consciousness and basic vital signs. More advanced indications of increasing intracranial pressure include vomiting and decreased level of consciousness.

Given their inherent increase in capillary fragility, older individuals would most likely require a trip to the ED. The same goes for any patient on any sort of anticoagulant (including aspirin). — Sherril Sego, FNP-C, DNP (175-2)

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