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| ==Diagnosis==
| | #REDIRECT[[Head trauma (main)]] |
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| CT Guidelines
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| Inclusion = 'minor head trauma'
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| AMERICAN HEAD CT RULE
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| Minor head trauma = brief LOC after event, then GCS of 15
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| CT indicated for (if any present):
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| 1) Short term memory deficit ( >amnesia to the event; i.e. persistent anterograde amnesia)
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| 2) Evidence of trauma above clavicles (signs of linear, basilar, depressed skull fracture, scalp hematoma, soft-tissue injury)
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| 3) Headache
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| 4) Vomiting
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| 5) Age >60yrs
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| 6) Drug or EtOH intoxication (by suspicion, not nec lab tests)
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| 7) Seizure post trauma
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| *Coagulopathy (including coumadin)
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| (NEJM 7/00, Haydel)
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| CANADIAN HEAD CT RULE
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| Minor head trauma = witnessed LOC, definite amnesia, witnessed disorientation w/ GCS 13-15
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| CT indicated for (if any present):
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| A. High Risk (for neurological intervention)
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| 1) GCS <15 2hrs post accident
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| 2) Suspected open/depressed skull fx
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| 3) Any sign of basal skull fracture (hemotympanum, racoon eyes, CSF otorrhea/ rhinnorrhea, Battle's sign)
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| 4) Vomiting >2 episodes
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| 5) Age >=65
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| B. Medium risk (for brain injury on CT)
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| 6) Amnesia >30 mins pror to impact
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| 7) Dangerous mechanism (struck by MVA, ejected from MV, fall from height > 3ft or 5 stairs.)
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| ==DDx==
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| 1. DAI
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| 2. Contusion
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| 3. Epidural
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| 4. Subdural
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| 5. Traumatic SAH
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| -Rx w/ Ca-blockers
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| 6. Intracerebral
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| 7. Concussion
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| -return to sports 1 wk after asympt
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| -1 mo if LOC/prolonged amnesia
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| -postconcussive synd (50% chance HA/irritability/seep/depression if HA/nausea/dizziness)
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| ==Treatment==
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| 1. ABCs
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| 2. HOB Elevated
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| 3. Sx Prophy (see other)
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| Dilantin 13-18mg/kg IV over 20min
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| 4. CO2
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| (PCo2 30-35 if sx herniation)
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| 5. Prevent
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| -Hypotension
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| -Hypoxia
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| -Anemia
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| -Hyperthermia
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| -Coagulopathy
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| ==See Also==
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| Peds: Head Trauma (Peds)
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| ==Source==
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| (Lancet 5/01, Stiell) | |
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| 2/6/06 DONALDSON (adapted from Lampe)
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| [[Category:Trauma]]
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