Flashcards in Head and C-spine injury Deck (5)
a) Neuro obs - what to assess?
b) Neuro obs - how often to assess?
c) Who to CT?
d) Previously normal CT - when to repeat?
a) Neuro obs:
- pupil size and reactivity;
- limb movements;
- SpO2, RR, HR, BP, Temp
b) For GCS 15*: (if remaining in hospital)
- Half-hourly for 2 hours.
- Then 1-hourly for 4 hours.
- Then 2-hourly thereafter.
*If at any stage GCS drops below 15, restart half-hourly neuro obs
c) - High-energy mechanism of injury
- Symptoms: LOC, amnesia, progressive/severe headache, vomiting, neck pain (C-spine CT)
- Signs: reduced GCS, focal neurology, signs of basilar skull fracture
- Other factors: anticoagulation, intoxication/drug use
d) Normal CT scan but not achieved GCS equal to 15 after 24 hours' observation (or deterioration)
Head injury: history
a) Mechanism - high-energy examples
b) Worrying symptoms at/since injury
c) Factors in DHx/SHx increasing the level of risk
a) - Fall from a height > 1 metre or 5 stairs.
- Diving accident.
- High-speed motor vehicle collision, either as a pedestrian, cyclist, or vehicle occupant.
- Rollover motor accident or ejection from vehicle.
b) - LOC, amnesia, progressive/severe headache, vomiting, neck pain
c) - Recent alcohol or drug intake.
- Current anticoagulation
Head injury: examination
a) Initial A-E assessment
b) Gross inspection of head
c) Worrying signs on neuro examination
d) Other examination to perform (*contraindicated in who?)
a) A-E assessment:
- Airway - GCS < 8?
- Breathing - hypoxia, abnormal breathing
- Circulation - shock, Cushing reflex, etc.
- Disability - GCS, glucose, pupils, focal neurology
- Exposure - bleeding, rashes
b) - Signs of visible trauma to the scalp, skull and neck
- Basilar skull fracture: periorbital / mastoid ecchymosis, CSF rhinorrhoea / otorrhoea, haemotympanum, new deafness
c) - Pupillary abnormality
- Cranial nerve palsy
- Any focal neurological deficit, such as: dysphasia,
ataxia, reduced power or abnormal sensation,
d) C-spine exam* - signs of a possible C-spine injury:
- Midline cervical spine tenderness
- Lateral rotation restricted to < 45 degrees to left + right
- High-energy vehicle collision.
- Neck uncomfortable/painful in a sitting position.
- Non-ambulatory at any time since the injury.
- No midline cervical spine tenderness.
Head injury in children: when to consider NAI
a) Site and character of bruise/injury
b) Child age/demographic
c) Other injuries/clinical signs
d) Other factors in the presentation
a) The injury or bruise is:
- On any non-bony part of the face (including eyes/ ears)
- On both sides of the face or head.
- Disproportionate to the explanation of injury
- Present in multiple sites or in clusters.
- Of a similar shape and size.
b) The child is not yet independently mobile (crawling, cruising, walking).
c) - Retinal haemorrhages
- Rib fractures
d) - The explanation for the injury is implausible, inadequate, or inconsistent (eg. between parents or carers; between accounts over time)
- There is a delay in presentation.