Traumatic Brain Injury with Midface Swelling

As the duty anaesthetist in a tertiary hospital, you are asked to attend the emergency department for the impending arrival of a 38-year-old male who has been struck on the head while working on a building site. On arrival with the paramedics he is unconscious with a laryngeal mask airway in situ. He has a compression bandage applied to his head and severe right periorbital and midface swelling. The initial observations from the paramedics are as follows: Heart rate 76 bpm Blood Pressure 167/90 mmHg SpO2 90% spontaneous ventilating on a T-piece with oxygen at 15 L/min Respiratory rate 28/min Left pupil size 4 and non-reactive Right pupil size 2 and sluggishly reactive