Head injury Flashcards
What is the most comomn cause of mortality and morbidity in th UK in children over 1 year?
Head injury
How quickly do most children recover from a head injury?
Within 2 weeks
What are red flag symptoms in head injury indications for?
Significant trauma or raised ICP
What age group of children should always go to hospital with a head injury?
Under 1 yera olds
(More likely to be NAI)
Questions to ask in history of head injury
Mechanism- speed/height
When
LOC - For how long, Seizures/abnormal behaviour
Vomitting - EPISODES
Headache
Altered behaviour
Clinical course - improving, stable, deteriorate
Other injuries eg cervical spine
Anti-coagulants
Unattended child, possible NAI
How many vomitting episodes is normal in a child after head injury
Up to two
(two in quick succession = one episode)
Examples of high energy head injuries
High speed/rollover motor vehicle collision
Child hit/ejected from vehicle
fall > 1m height
Bicycles
Fall/trampled large animal
Golf club, cricket/baseball bat
Paediatric GCS under one year eye opening
Spontaneously - 4
Tp shout - 3
To pain - 2
No response - 1
Motor response in under 1 year scale GCS
Spontaneous - 6
Localises pain - 5
Flexion-withdrawal - 4
Felxion abnormal (decorticate rigidity) - 3
Extension - decerebrate rigidity) - 2
No response - 1
0-23 months GCS verbal response
Smiles/coos appropritately - 5
Cries and is consolable - 4
Persistent inappropriate crying and/or screaming - 3
Grunts, agitated, restless - 2
No response - 1
2-5 years GCS verbal response
Appropriate words/phrases - 5
Inappropriate words - 4
Persistent cris and screams - 3
Grunts - 2
No response - 1
> 5 years verbal response GCS
Oriented - 5
Disoriented/confused - 4
Inappropriate words - 3
Incomprehensible sounds - 2
No response - 1
Red flags in head injury GCS immediate vs 2 hours
Immediaet - GCS < 14 , children < 1 year GCS <15
21 hours after GCS < 15
Red flags in head injruy paeds
GCS <14 immediate, < 15 if under 1 year
GCS < 15 2 hours after
Open or depressed skull fracture or tense fontanelle
Sign of basal skull fracture
Focal neurological deficit
Post-traumatic seizure, no epilepsy history
Sus NAI
LOC > 5 mins - witnessed
Abnormal rowsiness
>3 episodes discreet vomitting
Dangerous mechanism of injury
Amnesia > 5 mins
>5cm mark on head < 1 year
What size laceration bruise or swelling is a red flag in a child under 1 year?
> 5cm
What size laceration bruise or swelling is a red flag in a child under 1 year?
> 5cm
Signs of basal skull fracture
Haemotympanum
Panda eyes
CSF from ears or nose
Battles sign
Post head injury advice for parents
Dont leave alone for 24 hours
Allow to sleep - observe regular, check repsond touch, breathe and position normal
Observe for next 2-3 dyas and check they’re responding as usual
Rest + avoid stress
Check respond normally move arms and legs
Paracetemol and ibuprofen if pain
Cold facecloth 20 miins every 3-4 hours if swollen or bruised
Completely revoered before back to school
No contact sport for 3 weeks
How long can a child go before doing ontact sport again agter a singificatn head injury?
3 weeks
