1.2 MTB Step 3 - Trauma (Head)

Question 1

MANAGEMENT STEPS

“A man was hit over the head with a baseball bat during a mugging. He has a scalp laceration and a linear skull fracture on CT Scan. He denies loss of consciousness. There are no neurological signs on exam.”

Is Surgery indicated?

Answer 1

No surgery is needed for an Asymptomatic Head Injury with a Closed Skill Fracture alone.

Question 2

MANAGEMENT STEPS

What is the Next Step in Management for an Asymptomatic Head Injury with a Closed Skill Fracture alone?

Answer 2

CLEAN any Lacerations

Question 3

MANAGEMENT STEPS

“A man was hit over the head with a baseball bat during a mugging. He has a scalp laceration and a comminuted, depressed fracture is seen on CT Scan. He denies loss of consciousness. There are no neurological signs on exam.”

Is Surgery indicated?

Answer 3

• Surgery, (Repair** or **Craniotomy) is considered for Comminuted or Depressed Skull Fracture, even if the patient is Asymptomatic.
• Send the patient to the Operating Room (OR)

Question 4

MANAGEMENT STEPS

“A man was hit over the head with a baseball bat during a mugging. He reports ‘being out of it for a few seconds,’ but then he came to without any symptoms. There are no neurological signs on exam.”

What is the Next Step in Management?

Answer 4

The first step in management for Head Trauma + LOC :

CT Head & Neck w/o contrast.

Question 5

MANAGEMENT STEPS

What else should be given to ALL patients with Open Skull Fractures?

Answer 5

Give Tetanus Toxoid and Prophylactic Antibiotics to ALL patients with Open Skull Fractures.

Question 6

BASAL SKULL FRACTURE

What are (3) Physical Signs to look for in a patient with a Basal Skull Fracture?

Answer 6

1. “Black Eyes” (Raccoon Eyes) - ecchymosis around both eyes.
2. Battle Sign - ecchymosis behind the ear.
3. CSF Leak - clear fluid dripping from the ear or nose.

Question 7

BASAL SKULL FRACTURE

What is the Best INITIAL Diagnostic Test for a suspected Basal Skull Fracture?

Answer 7

CT Scan of Head & Neck

Question 8

BASAL SKULL FRACTURE

What Disorder may occur 2 - 3 days AFTER a Basal Skull Fracture?

Answer 8

Facial Palsy due to Neurapraxia

Question 9

EPIDURAL HEMATOMA

“A 14-yo boy is hit over the side of the head with a baseball bat. He loses consciousness for a few minutes, but he recovers promptly ad wished to continue playing. He is brought to the ED; the CT shows a bi-convex light area on the right side. The patient has no complaints and has no neurologic dysfunction on exam.”

What is the Next Step in Management?

Answer 9

Emergency Craniotomy

The patient is at risk of sudden deterioration.

Question 10

EPIDURAL HEMATOMA

What is the Common Presentation for an Epidural Hematoma?

Answer 10

Trauma

and

Sudden LOC

Question 11

EPIDURAL HEMATOMA

What is the Most Common Vascular cause of an Epidural Hematoma?

Answer 11

Middle Meningeal Artery

The Middle Meningeal Artery is the 3rd Branch of the Maxillary Artery, which is a Branch of the External Carotid Artery.

Question 12

EPIDURAL HEMATOMA

What is the period “when the patient immediately awakens and appears normal” called when speaking of Epidural Hematoma?

Answer 12

Lucid Interval

Epidural ⇒ Biconvex ⇒ Middle Meningeal Artery ⇒ Lucid Interval

Question 13

EPIDURAL HEMATOMA

What is the Best Diagnostic Test for Epidural Hematoma?

Answer 13

CT Scan Head w/o contrast

shows a Lens-Shaped Hematoma (biconvex) with or without midline deviation.

Question 14

EPIDURAL HEMATOMA

What is the Best Treatment for Epidural Hematoma?

Answer 14

Emergency Craniotomy

If the patient is treated = Good Prognosis

If the patient is NOT treated = Fatal within hours

Question 15

SUBDURAL HEMATOMA

What is the Most Common Vascular cause of a Subdural Hematoma?

Answer 15

Bridging Veins

Bleeding is Low Pressure (slower bleed)

Question 16

SUBDURAL HEMATOMA

What is the Most Common Presenting History for Subdural Hematoma?

Answer 16

Head Trauma

with

Fluctuating Consciousness

Gradual: headaches, memory loss, personality changes, dementia, confusion, drowsiness)

Question 17

SUBDURAL HEMATOMA

What is the Best Diagnostic Test for Subdural Hematoma?

Answer 17

CT Scan Head w/o contrast

shows Semilunar (Crescent-shaped) Hematoma with or without midline deviation.

Subdural ⇒ Crescent-shaped ⇒ Bridging Veins ⇒ Gradual Loss of Consciousness

Question 18

SUBDURAL HEMATOMA

What is the Best Treatment for Subdural Hematoma?

Answer 18

Emergency Craniotomy

done ONLY IF there are Lateralizing signs and Midline Displacement of 10 mm or more.

Question 19

DIFFUSE AXONAL INJURY

What is the Cause of Diffuse Axonal Injury?

Answer 19

Acceleration-Deceleration Injuries to the Head

Question 20

DIFFUSE AXONAL INJURY

What is Therapy directed at in the Treatment of Diffuse Axonal Injury?

Answer 20

Preventing further Injury from Increased Intracranial Pressure (ICP)