head injury Flashcards
History of head injury
What was the mechanism and force involved in the head injury?
If it was a fall, did they fall from standing height or from higher up?
Was there Loss Of Consciousness (LOC)? (Did they cry immediately/ in older children do they remember who was there and who called for help?)
How long was the LOC?
Was there any fitting?
Has the child been their normal self since?
Has the child been drowsy since?
Has the child been irritable since?
Has the child complained of headache since?
Has the child vomited since? How many times?
Vomiting, drowsiness or loss of consciousness may be indications for a scan. Follow local protocols or NICE guidelines.
Be aware of the possibility of Non Accidental Injury, particularly think of the possibility of an inflicted injury in a non-mobile, non-verbal child.
General behaviour in head injury
Observe the child and decide if they are just upset, or if they are truly irritable after a head injury
Check for drowsiness or confusion
Check and record AVPU scale or GCS. If P or U, may need anesthetist to secure airway. to prevent vomitting and aspiration.
Examine the head for the size of any swelling or laceration
If there is a bump feel to see if it is a depressed fracture or a soft boggy swelling (fractures require CT scan to look for underlying damage). Also, any sign of basal skull fracture such as battle sign or CSF leak is an indication for CT scan.
Examine fully for neurological deficits and boggy swellings require CT scan to look for underlying damage. Any suspected NAI needs a CT scan.
Usually, there is generalised cerebral oedema but sometimes there is a haemorrhage causing localised pressure effect. This may cause selective weakness of the arms and legs on one side, or a difference in the size of the pupils, so check for symmetry.
For a child <1 year of age a laceration or swelling on the head of more than 5cm is an indication for CT scan. Also any sign of basal skull fracture is an indication for CT scan.
Vomiting 3 or more times is an indication for CT scan.
See the NICE guideline for other indications for CT scan.
Be aware of the possibility of Non Accidental Injury.
If discharging a child home then give the parents ‘head injury advice’ for home.
