رجل عمره ٤٥ سنة دخل للمراقبة بعد ضربة على الرأس في العمل، والأشعة الأولى طبيعية. كان واعياً ومدركاً قبل ساعة، والآن صار متململاً ويكرر نفس السؤال. الحدقتان متساويتان وتستجيبان، والضغط ١٢٨/٨٠، والنبض ٨٤. ما التصرف الأولوية؟

A 45-year-old man is admitted for observation after a blow to the head at work; the initial CT is normal. He was alert and oriented an hour ago but is now restless and repeating the same question. Pupils are equal and reactive, BP 128/80, HR 84. What is the priority action?

1. Document it as anxiety, reassure the client and stay with him
2. Notify the provider now of the change in consciousness
3. Give the PRN sedative as prescribed to calm the restlessness
4. Reassess in 4 hours because the vital signs are normal

Answer: B) Notify the provider now of the change in consciousness. A change in level of consciousness, even subtle restlessness or confusion, is the earliest sign of raised intracranial pressure; pupil and vital-sign changes come late. A sedative masks neurological signs, and waiting 4 hours is dangerous.