Skull fracture: A skull fracture is a break in the skull bone, and there are four major types:.Despite being fairly minor, a scalp laceration can yield a surprising amount of blood because the scalp is heavily populated with blood vessels. Scalp laceration: A scalp laceration is a breaking or tearing open of the skin on the head.There are several different types of head injuries: Treatment depends on the severity of the trauma and ranges from a non-invasive approach−such as rest or medication−to open surgery.Īlthough most instances of head trauma are mild and individuals who sustain such injuries have full recoveries, other injuries to the head are common causes of disability and death in both adults and children. Intracranial lesions are more likely in the presence of skull fractures.Head trauma is a broad designation that describes a vast array of injuries to the scalp, skull, brain, underlying tissue, and blood vessels in the head. Neurosurgical consultation is required and operative intervention may be necessary. Some advocate observation and / or repeat scanning in 24-48 hours.Īll of these lesions may occur in isolation or in combination, and may present with altered mental state for focal neurological deficits. ![]() Due to tearing of veins draining cerebral cortex. More common - especially in the presence of cerebral atrophy (e.g. <50%) have lucid period after injury before subsequently deteriorating (aka “talk and die”). Most commonly (80%) due to tearing of middle meningeal artery due to a temporal fracture Extradural haemorrhage (aka epidural hemorrhage).These range from simple concussion with an excellent prognosis to diffuse axonal injury with associated grim prognosis.Transfer to neurosurgical unit/ ICU for ongoing care Neurosurgery to consider ICP monitor insertion Targets: PaO2 >100 mmHg, PaCO2 35 mmHg, T 36-37C, MAP>70 mmHg (CPP 50-70 mmHg if ICP monitor is placed), glucose 6 – 10 mmol/L Continued post-resuscitation care and monitoring.Organize CT head to define the nature of the traumatic brain injury Head-to-toe examination looking for other injuries Organize early transfer to a neurosurgical unit Bedside ultrasound to identify other injuries and sources of haemorrhage (e.g. Obtain trauma series radiographs as needed (lateral cervical spine XR, chest XR, pelvic XR) ECG and full non-invasive monitoring including temperature Adjuncts to Primary Survey and Resuscitation.maintain T36-37 give antipyretics if T>38C treat seizures and consider prophylactic anticonvulsants according to local guidelines. Airway maintenance with cervical spine immobilization.Primary survey and resuscitation (ABCDE approach).Remove the patient from a rigid spine board as soon as possible by transferring onto a trauma bed.Activate the trauma team and use a coordinated team-based approach in a dedicated trauma bay appropriately staffed and equipped for resuscitation.National Emergency X-Radiography Utilization Study (NEXUS)-II. ![]() The 3 major adult CT Clinical decision rules are summarised at Academic Life in Emergency Medicine in a handy ‘Paucis Verbis’ card: Head CT Decision Rules in Trauma Of note, the Canadian CT Head Rules were designed to be used in GCS 13-15 patients with witnessed loss of consciousness, amnesia to the head injury event, or confusion. In practice, I use the Canadian CT Head Rules (available here at MDCalc) in combination with clinical judgment and considerations such as coagulopathy, GCS <13 and focal neurology as listed above. pedestrian versus vehicle, fall >1m or 5 stairs, ejected from motor vehicle) ![]()
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