Ch58 Pediatric head injury Flashcards
(21 cards)
Why do paediatric patients develop severe cerebral swelling after head injury?
Malignant cerebral oedema due to hyperaemia
What are the CT head recommendations in children?
PECARN algorithm: <2 years with GCS<14 or palpable skull # Large scalp haematoma LOC>5 seconds Severe mechanism of injury >2 years with GCS14 or signs of base of skull # LOC Vomiting Severe mechanism Severe headache
What are the NICE guidelines for CT head in children?
Suspicion of NAI Post-traumatic seizure GCS<15 Open / depressed skull fracture / tense fontanelle Sign of base of skull fracture Neurological deficit If <1 year swelling >5 cm Other factors include LOC>5 mins, drowsiness, >2 vomits, dangerous mechanism and amnesia >5 mins
What are the NICE guidelines for CT head in Adults?
GCS<13 on arrival or <15 within 2 hours Open or depressed or base of skull fractures Post-traumatic seizure Focal neurologicla defcit >1 vomit Other factors are age >65 years, clotting disorders / anticoagulants and dangerous mechanism (defined as fall from height >1 metre)
What are the NEXUS criteria?
To be able to clear the C-spine clinically (mnemonic = NSAID) - Absence of neurologicla deficit, spinal tenderness, Altered conciousness, intoxication and distracting injury
What are the Canadian C-spine rules?
Rules for C-spine imaging (mnemonic = MAP SPAM) High risk: Mechanism Age>65 Paraesthesias in U&LL Low risk: Simple mechanism Prolonged duration before pain Ambulatory after injury Midline tenderness absent Movement normal
When do you intubate a trauma patient?
GCS 8 or less Loss of laryngeal reflex Ventilatory failure Hyperventilation pCO2<4 Irregular respirations
What pCO2 should you aim for following head injury?
PaCO2 4.5-5 kPa unless raised ICP in which case more aggressive hyperventilation is justified.
Which patients should be admitted for observation following head injury?
Abnormality on imaging GCS<15 Any other concerning features - intoxication, shock, NAI, CSF leak, meningism etc
How often should observations be performed following head injury for admitted patients?
Every 30 mins for 2 hours 1 hourly for 4 hours Then 2 hourly
Which paediatric scalp haematomas calcify?
Subperiosteal NOT subgaleal haematomas
How do you differentiate subperiosteal from subgaleal haematomas?
Subperiosteal haematomas are limited by sutures
What is the treatment for large scalp haematomas?
Transfuse if anaemic. Do no aspirate them!
What are growing skull fractures?
Post-traumatic leptomeningeal cysts - 0.6% of fractures. Requires a skull fracture and a dural tear. <3 years old.
How do you treat a growing skull fracture?
Large craniotomy as the dural edges will be far from the bone defect. Repair of the dural defect is required and replacement of the bone.
What is the significance of a retroclival haematoma?
May be associated with atlanto-occipital dislocation. Blood may be extradural or subdural. Look for cranial nerve palsies and quadriplegia. Note the tectorial membrane is raised!
What is a surrogate imaging marker for atlanto-axial dislocation?
Apical ligament rupture
How do you treat retroclival haematomas?
Depends on the cause. If atlanto-occipital disruption, clival or condylar fracture then halo or neck collar.
Haematoma evacuation only needed if causing brainstem compression
What proportion of head injuries are NAI?
10% of <10 year olds with head injury
What factors are suggestive of NAI?
Bilateral subdurals
Retinal haemorrhages
Multiple injuries or different ages
Significant neurological injury with minimal signs
Inconsistent history
What is Purtscher’s retinopathy?
Loss of vision following trauma due to acute rise in ICP. Haemorrhages are seen around the optic disc.
