Head trauma / injury

Question 1

Airway

Answer 1

Throught my assessment I would be looking for signs of raised ICP + criteria for a CT head

C-spine immobilisation

Question 2

Breathing

Answer 2

Look: respiratory arrest, increased work of breathing
Listen: vesicular sounds
Feel: percuss, trachea central

O2, RR

ABG: lactate
XCR - for aspiration

Question 3

Circulation

Answer 3

Look: mottled anaemia
Listen: S1,S2
Feel: CRT, pulse

HR, BP - haemodynamically unstable if bleeding

ECG

Get IV access
Bloods: FBC, UEs, LFTs, CRP
Surgical as well: crossmatch, clotting

Question 4

Disability

Answer 4

1. PEARL
2. GCS score
3. Full neurological examination: any focal neurology
4. Fundoscopy: pappiloedema
5. Drug chart: anticoagulation
6. CT head STAT
7. BM

Question 5

Exposure

Answer 5

Urine tox screen
Rashes
Caves
Abdo exam
Temperature

Question 6

Criteria for CT head

Answer 6

CT head guidelines: within 1 h

1. GCS<13 on initial assessment in ED
2. GCS<15 when assessed 2h after injury in ED
3. Suspected open or depressed skull fracture
4. Any sign of basal skull fracture (hameotympanum – ‘panda’ eye, CSF leakage from ear or nose + Battle’s sign)
5. Post-traumatic seizure
6. Focal neurological deficit
7. More than 1 episode of vomiting
8. Coagulopathy: a. Bleeding hx b. Warfarin

Should be imaged within 8h of injury / immediately if present 8h or more after injury
If amnesia/ LOC since injury +
1. Age>65
2. Dangerous mech of injury
3. More than 30 mins
retrograde amnesia of events immediately before the head injury
4. Coagulopathy:
a. History of bleeding b. Clottingdisorder
c. Current treatment of
warfarin

Neurosurgery review
ITU