Please enable JavaScript.
Coggle requires JavaScript to display documents.
Head Injury - Coggle Diagram
Head Injury
Indicators of potentially serious head injury
witnessed LOC >5min
amnesia >5min
abnormal drowsiness
3+ vomiting episodes
clinical suspicion of NAI
post-traumatic seizure w/o epilepsy hx
GCS < 15 (<14 if under 1)
suspicion of open/depressed skull injury/tense fontanelle
sign of basal skull #
CSF otorrhoea
CSF rhinorrhoea
periorbital bruising (panda/racoon eyes)
bruising over mastoid (Battle sign)
haemotympanum
under 1 + swelling >5cm
dangerous mechanism
high speed RTA
fall from >3m
high speed injury from projectile object
Management
aim = identify children requiring tx + avoid secondary brain damage
make sure it isn't NAI
mild: discharge home with written advice
potentially severe: monitor to avoid secondary damage
severe: resus, CT, neurosurg referral
Primary surgery: ABCDE
Secondary survey
observe for secondary damage
persistent coma
deteriorating GCS
seizures without full recovery
focal neuro signs
Accidental aka unintentional injury
extremely common
M>F
brain damage from head injury = major cause of disability from accidents
Intro
minor ones common in childhood
vast majority recover
1 in 800 develop serious problems
Damage caused by head injuries
primary
concussion (reversible impairment of consciousness)
intracerebral contusion
cranial vol may increase in infants
as skull sutures are open
due to bleed
Hb conc falls
may become shocked
before neuro signs/sx occur
cerebral lacerations
dural tears
diffuse axonal damage
secondary
haematoma
subdural
extradural
intracranial
Hypoxia
airway obstruction
inadequate ventilation
hypo / hyperglyc
reduced cerebral perfusion
bleeding
raised ICP
infection from open wound/CSF leak