**Question:** The first priority in management of a case of head injury with open fracture of shaft of femur is:

A. Stabilizing the fracture
B. Assessing the Glasgow Coma Scale (GCS)
C. Performing a computed tomography (CT) scan
D. Administering pain relief

**Correct Answer:** B. Assessing the Glasgow Coma Scale (GCS)

**Core Concept:**
In cases of head injury, assessing the Glasgow Coma Scale (GCS) is crucial for determining the severity of the injury and guiding subsequent treatment decisions. The GCS evaluates a patient's level of consciousness based on three components: eye opening, verbal response, and motor response. A lower GCS score indicates more severe injury and requires immediate attention.

**Why the Correct Answer is Right:**
The correct answer, assessing the GCS (Glasgow Coma Scale), is essential because it provides a quantitative method to evaluate the patient's neurological status following a head injury. This helps in determining the severity of the injury and guides the management decisions, including further investigations, monitoring, and treatments.

**Why Each Wrong Option is Incorrect:**
A. Stabilizing the fracture (Option A) is important but comes after assessing the GCS, as the neurological status needs to be evaluated before any treatment intervention.

C. Performing a computed tomography (CT) scan (Option C) is important but not the first priority; assessing the GCS is the initial step, followed by considering a CT scan if needed for further evaluation.

D. Administering pain relief (Option D) is essential, but it should be done after evaluating the GCS and considering the patient's overall clinical condition, as pain management should be prioritized based on the severity of the injury.

**Clinical Pearls:**
1. **GCS is crucial for determining the severity of head injury:** A lower GCS indicates more significant brain damage, which influences the management decisions.
2. **Timely assessment of GCS ensures appropriate treatment planning:** Assessing the GCS before any treatment intervention helps guide subsequent steps.
3. **A step-by-step approach for managing head injury:** First, assess GCS, then stabilize the fracture, consider CT scan if needed, and provide pain relief based on the GCS and overall clinical condition.
4. **GCS helps in determining the need for further investigations:** A lower GCS might require a CT scan to rule out additional injuries or assess the extent of brain damage.