Trauma - Head

Question 1

Penetrating Trauma
-Diagnosis
-Management
vs

Answer 1

Penetrating

• No diagnosis as its visible
• Surgery

Blunt
-Diagnosis - CT scan

Question 2

Basilar skull fractures

• Signs
• Management

(racoons like basil, then put racoons neck in CT scan)

Answer 2

Signs
-Racoon eyes, battle signs or oto-rinorrhea (clear CSF) = fracture at base of skull

Management
-CT scan of head and neck

Question 3

Acute Epidural Haematoma
Presentation
(skull and dura)

Epi-lemon

Answer 3

Presentation - trauma to side of head

• shattering of middle meningeal artery that can expand
• LOC –> Ictal period –> Coma
• can get ipsilateral fixed dilated pupil and contralateral hemiparesis

Diagnosis - CT scan (lemon shape)

Treatment - Emergency Craniotomy and evacuation

Question 4

Acute subdural Hematoma

Eat banana in submarine

Who gets this?
Diagnosis
Treatment

Answer 4

Young person, significant amount of force (car accident, shake baby)
-Usually LOC without lucid interval and doesnt get worse (e.g knocked out - doesnt wake up)

Diagnosis - CT

Treatment - craniotomy if midline shift, or goal to decrease ICP

Question 5

Signs of Increased ICP and treatment

Answer 5

Signs
-bradycardia, hypertension, respiratory depression, fixed and dilated pupils, vomiting, papilledema.

-Elevation
-Hyperventilation
-Mannitol
(consider surgical decompression)

Question 6

Chronic subdural hematoma

• Who gets it?
• Diagnosis?
• Treatment?

Answer 6

-elderly, demented patients, alcoholics - brain atrophy, and moved the bridgine vein so that minor trauma can shear vein.

Gradually deteriorating mental function - dementia, often with a headache.

CT scan - crescent shaped

Treatment –> dementia + neuro symptoms - evacuate

Question 7

Diffuse axonal injury

Answer 7

Angular trauma - spinning in a car-axon fibers can shear

• Blurring and haemorrhaging of the grey-white matter junction on MRI
• Coma
• Little can be done –>monitor and manage ICP

Question 8

Concussion

• What to do?
• Who gets CT?
• Treatment?

Answer 8

-If there is loss of consciousness with retrograde emnesia, then patient likely has concussion.

• Sports injuries - CT
• if it is normal, they go home.

Cognitive and physical rest