Head trauma (adult): Difference between revisions

(Created page with "==Diagnosis== CT Guidelines Inclusion = 'minor head trauma' AMERICAN HEAD CT RULE Minor head trauma = brief LOC after event, then GCS of 15 CT indicated for (if any pres...")
 
No edit summary
Line 1: Line 1:
==Diagnosis==
==Diagnosis==


CT Guidelines
CT Guidelines


Inclusion = 'minor head trauma'
Inclusion = 'minor head trauma'


AMERICAN HEAD CT RULE
AMERICAN HEAD CT RULE
*Minor head trauma = brief LOC after event, then GCS of 15


Minor head trauma = brief LOC after event, then GCS of 15
*CT indicated for:
 
#Short term memory deficit (more than amnesia to the event; i.e. persistent anterograde amnesia)
CT indicated for (if any present):
#Evidence of trauma above clavicles
 
#Headache
1) Short term memory deficit ( >amnesia to the event; i.e. persistent anterograde amnesia)
#Vomiting
 
#Age > 60yrs
2) Evidence of trauma above clavicles (signs of linear, basilar, depressed skull fracture, scalp hematoma, soft-tissue injury)
#Drug or EtOH intoxication (clinical impression, not by labs)
 
#Seizure post trauma
3) Headache
 
4) Vomiting
 
5) Age >60yrs
 
6) Drug or EtOH intoxication (by suspicion, not nec lab tests)
 
7) Seizure post trauma


*Coagulopathy (including coumadin)
*Coagulopathy (including coumadin)
(NEJM 7/00, Haydel)


CANADIAN HEAD CT RULE
CANADIAN HEAD CT RULE
*Minor head trauma = witnessed LOC, definite amnesia, witnessed disorientation w/ GCS 13-15


Minor head trauma = witnessed LOC, definite amnesia, witnessed disorientation w/ GCS 13-15
*CT indicated for:
 
#GCS <15 2hrs post accident
CT indicated for (if any present):
#Suspected open/depressed skull fx
 
#Any sign of basal skull fracture (hemotympanum, racoon eyes, CSF otorrhea/ rhinnorrhea, Battle's sign)
A. High Risk (for neurological intervention)
#Vomiting >2 episodes
 
#Age >=65
    1) GCS <15 2hrs post accident
#Amnesia >30 mins pror to impact
 
#Dangerous mechanism (struck by MVA, ejected from MV, fall from height > 3ft or 5 stairs)
    2) Suspected open/depressed skull fx
 
    3) Any sign of basal skull fracture (hemotympanum, racoon eyes, CSF otorrhea/ rhinnorrhea, Battle's sign)
 
    4) Vomiting >2 episodes
 
    5) Age >=65
 
B. Medium risk (for brain injury on CT)
 
    6) Amnesia >30 mins pror to impact
 
    7) Dangerous mechanism (struck by MVA, ejected from MV, fall from height > 3ft or 5 stairs.)
 


==DDx==
==DDx==


 
#DAI
1. DAI
#Contusion
 
#Epidural
2. Contusion
#Subdural
 
#Traumatic SAH
3. Epidural
#Intracerebral
 
#Concussion
4. Subdural
 
5. Traumatic SAH
 
    -Rx w/ Ca-blockers
 
6. Intracerebral
 
7. Concussion
 
    -return to sports 1 wk after asympt
 
    -1 mo if LOC/prolonged amnesia
 
    -postconcussive synd (50% chance HA/irritability/seep/depression if HA/nausea/dizziness)
 


==Treatment==
==Treatment==
 
#ABCs
 
#HOB Elevated
1. ABCs
#Sz Prophy
 
*Dilantin 13-18mg/kg IV over 20min
2. HOB Elevated
#Maintain CO2 30-35 if suspect herniation
 
#Prevent:
3. Sx Prophy (see other)
*Hypotension
 
*Hypoxia
    Dilantin 13-18mg/kg IV over 20min
*Anemia
 
*Hyperthermia
4. CO2
*Coagulopathy
 
    (PCo2 30-35 if sx herniation)
 
5. Prevent
 
    -Hypotension
 
    -Hypoxia
 
    -Anemia
 
    -Hyperthermia
 
    -Coagulopathy
 


==See Also==
==See Also==


Peds: Head Trauma (Peds)
Peds: Head Trauma (Peds)
Line 125: Line 62:
==Source==
==Source==


 
*(NEJM 7/00, Haydel)
(Lancet 5/01, Stiell)
*(Lancet 5/01, Stiell)
 
2/6/06 DONALDSON (adapted from Lampe)
 
 




[[Category:Trauma]]
[[Category:Trauma]]

Revision as of 23:11, 2 April 2011

Diagnosis

CT Guidelines

Inclusion = 'minor head trauma'

AMERICAN HEAD CT RULE

  • Minor head trauma = brief LOC after event, then GCS of 15
  • CT indicated for:
  1. Short term memory deficit (more than amnesia to the event; i.e. persistent anterograde amnesia)
  2. Evidence of trauma above clavicles
  3. Headache
  4. Vomiting
  5. Age > 60yrs
  6. Drug or EtOH intoxication (clinical impression, not by labs)
  7. Seizure post trauma
  • Coagulopathy (including coumadin)

CANADIAN HEAD CT RULE

  • Minor head trauma = witnessed LOC, definite amnesia, witnessed disorientation w/ GCS 13-15
  • CT indicated for:
  1. GCS <15 2hrs post accident
  2. Suspected open/depressed skull fx
  3. Any sign of basal skull fracture (hemotympanum, racoon eyes, CSF otorrhea/ rhinnorrhea, Battle's sign)
  4. Vomiting >2 episodes
  5. Age >=65
  6. Amnesia >30 mins pror to impact
  7. Dangerous mechanism (struck by MVA, ejected from MV, fall from height > 3ft or 5 stairs)

DDx

  1. DAI
  2. Contusion
  3. Epidural
  4. Subdural
  5. Traumatic SAH
  6. Intracerebral
  7. Concussion

Treatment

  1. ABCs
  2. HOB Elevated
  3. Sz Prophy
  • Dilantin 13-18mg/kg IV over 20min
  1. Maintain CO2 30-35 if suspect herniation
  2. Prevent:
  • Hypotension
  • Hypoxia
  • Anemia
  • Hyperthermia
  • Coagulopathy

See Also

Peds: Head Trauma (Peds)


Source

  • (NEJM 7/00, Haydel)
  • (Lancet 5/01, Stiell)
Retrieved from "https://www.wikem.org/w/index.php?title=Head_trauma_(adult)&oldid=1901"