What is the appropriate initial step in the management of a patient with a mild traumatic brain injury presenting with repeating vomiting?

In the scenario where a patient presents with mild traumatic brain injury accompanied by repeated vomiting, obtaining a CT scan without contrast is the appropriate initial management step. The presence of repeated vomiting following a head injury raises concern for potential intracranial complications, such as a concussion, intracranial hemorrhage, or other structural injuries that may not be immediately evident. A CT scan is crucial as it provides rapid imaging to evaluate for these possible complications.

The use of a CT scan without contrast is particularly indicated in this situation since it is a standard approach for assessing acute head injuries. This imaging modality allows for the identification of bone fractures, bleeding (e.g., epidural or subdural hematomas), and other intracranial pathologies that may necessitate further intervention.

While monitoring the patient for a few hours could be a consideration if the symptoms were less concerning, the ongoing vomiting indicates a need for more immediate assessment to rule out serious injury. Immediate surgery is not warranted without prior imaging findings that indicate a surgical emergency, and referral to a specialist would typically occur after a definitive diagnosis is made. Therefore, performing a CT scan is the best initial step in appropriately managing this patient.