Head injury Flashcards
CT head immediately criteria
GCS < 13 on initial assessment
GCS < 15 at 2 hours post-injury
suspected open or depressed skull fracture
any sign of basal skull fracture
post-traumatic seizure
focal neurological deficit
more than 1 episode of vomiting
CT head scan within 8 hours of the head injury
for adults with any of the following risk factors who have experienced some loss of consciousness or amnesia since the injury:
- age 65 years or older
- any history of bleeding/clotting disorders
-dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs)
- more than 30 minutes’ retrograde amnesia of events immediately before the head injury
Extradural haemorrhage
Bleeding outside the dura
Middle meningeal artery rupture
Biconvex or lenticular , lemon shape
Head trauma, LOC, then “Lucid” interval classically as pressure inside increases as a result of haematoma. Period where there is temporary improvement in a patient’s condition following injury after which the condition deteriorates
Mostly due to trauma
Subdural haemorrhage
Tearing of bridging veins between brain and dura mater
Risk factors include old age, alcoholism and anticoagulation
concave/ banana shape
Patients complain of fluctuating and gradually worsening confusion
Sub arachnoid haemorrhage
most common type of intracerebral haemorrhage
ruptured intracranial aneurysms
sudden onset worst headache ever. They may have collapsed or have signs of meningism (photophobia, nausea and neck stiffness)
Symptoms and signs basal skull fracture
Head injury
Reduced consciousness
Panda (or Racoon) eyes also called periorbital eccymoses (brusing around the eye)
Battle’s sign (bruising to the mastoid process) also called postauricular ecchymoses
Haemotympanum (bruising / bleeding visible behind the ear drum typanic membrane)
CSF rhinorhoea or otorhoea (clear fluid running out of nose/ears)
