Head Injury

Question 1

Head injury fall history

Answer 1

-Why: chest pain, palpitations
-Amnesia
-New vomiting since hitting head

Question 2

Examination of head injury

Answer 2

-Neuro exam full
-Blood behind eardrum, panda eyes, otorrhoea or rhinorrhoea
-Boggy

Question 3

Criteria for scan

Answer 3

-Reduced GCS <12 (alcohol?)
-Focal neurology
-See guidelines
-Seizure post-traumatic
-Anticoagulant with LOC, amnesia (30 minutes retrograde)

Question 4

Risk factors for subdural haemorrhage

Answer 4

-Elderly alcoholic
=White and bright if new
=Darker when matures
=Banana shaped

-Epidural lemon shaped

Question 5

Epidural haemorrhage presentation

Answer 5

-Reducing GCS
-Often with skull fracture
=6th nerve palsy due to swelling

Question 6

Discharge advice

Answer 6

-Always give verbal and written worsening advice
=Observe for 24 hours
=Access to phone
=Confusion, difficulty waking up, vomiting, seizure, vision problems, severe headache, passing out, weakness or numbness in arm or leg, watery fluid from ears or nose

Question 7

What is a minor head injury?

Answer 7

-GCS 14-15, should be 15 by one hour of observation or 2 hours from injury- or CT is indicated
-No other indications for CT head (or normal CT and symptoms now resolved)
-Patient can be discharged provided no other medical concerns and a sensible adult is available to observe

Question 8

Post concussion syndrome

Answer 8

-Can occur after minor head injury
-Usually resolved after 2 weeks

=Headache
=Dizziness
=Nausea
=Sensitivity to light, noise
=Sleep disturbance
=Memory problems
=Irritability
=Restlessness
=Impulsivity/ self control problems
=Difficulty concentrating
=Feeling depressed tearful/ anxious
=Fatigue
=Difficulties thinking or problem solving

-If prolonged can cause morbidity
-If not resolved by 2 weeks, consider referral to specialist head injury service, neurologist, neuropsychologist

Question 9

ED critical care for severe head injury

Answer 9

-Aim is to prevent secondary brain injury
A: secure airway and immobilise c-spine
B: oxygenation and ventilation PaO2>11)
C: adequate MAP (>70), transfuse if anaemia or hypovolaemic shock
D: treat seizures, hypoglycaemia, suspected raised ICP
E: normal temp, treat other injuries

-Sedation/paralysis, 10-15 degree head up tilt, ETT tape not tie for avoiding raised ICP