Martins et al reported a protocol for managing patients with gunshot wounds to the head. This can help decide if a patient should or should not undergo surgery. The authors are from Hospital Santa Marcelina in Sao Paulo, Brazil.
Parameters:
(1) Glasgow coma score (GCS)
(2) pupillary response
(3) significant hematoma with mass effect seen on CT scan
GCS
Pupillary Response
Hematoma
Management
3
fixed (nonreactive)
NA
no surgery
3
reactive
present
surgery
3
reactive
absent
no surgery
4 or 5
NA
present
surgery
4 or 5
NA
absent
no surgery
>= 6
NA
NA
surgery
where:
• Direct injury to the eye or ocular nerves may affect the pupillary response.
Surgery is recommended for a patient with a penetrating gunshot wound to the head and a Glasgow coma score is < 6 only when there is a hematoma causing a significant mass effect.
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