Head Injury

Question 1

What is the initial management for a head injury?

Answer 1

1. A-E, stabilise airway, GCS
2. Assess anterograde and retrograde amnesia
3. Lorazepam for seizures (AED prophylaxis)
4. FBC, U&Es, glucose, blood alcohol, toxicology, ABG, clotting
5. Pulse, BP, temperature, RR, pupils - every 15 mins
6. Full examination (including lacerations)
7. Check for CSF leak from nose/ear, check for signs of basal skull fracture
8. Palpate neck for tenderness
9. CT head and neck if indicated
10. Consider ICP monitoring if intubated

Question 2

What device is contraindicated in a basal skull fracture?

Answer 2

NG tube

Question 3

What are the classic signs of a basal skull fracture?

Answer 3

1. Periorbital ecchymosis

2. Postauricular ecchymosis

Question 4

What is it important to ask about in the history of a head injury and how do you reverse it?

Answer 4

Anticoagulation?

1. Platelet transfusion for aspirin/clopidogrel
2. IV vitamin K for warfarin
3. Trial PCC for DOACs

Question 5

What should you present to the neurosurgeons when referring a patient?

Answer 5

1. Brief history
2. GCS
3. Neurological exam
4. Anticoagulation
5. Scan results

Question 6

What are the indications for an immediate CT head?

Answer 6

1. GCS <13 on initial assessment
2. GCS <15 2 hours post-injury
3. Suspected skull fracture
4. Post-traumatic seizure
5. Focal neurological deficit
6. > 1 episode of vomiting

Question 7

What are the indications for a CT head within 8 hours if there is loss of consciousness or amnesia?

Answer 7

1. Age >65
2. Bleeding/clotting disorders
3. Fall >1m or >5 stairs
4. > 30 minutes retrograde amnesia