Head trauma (main)

Background

Clinical Presentation

Adult GCS

Eye Opening	Verbal	Motor
		6: Obeys commands
	5: Oriented	5: Localizes to pain
4: Spontaneously opens	4: Confused speech	4: Withdraws from pain (normal flexion)
3: Opens to command	3:Inappropriate words	3: Decorticate posturing (abnormal flexion)
2: Opens to pain	2: Incomprehensible sounds	2: Decerebrate posturing (extension)
1: Does not open	1: No response	1: No response

• 14-15: Mild
• 9-13: Moderate
• 3-8: Severe

Differential Diagnosis

Intracranial Hemorrhage Types

• Intra-axial
  • Hemorrhagic stroke (Spontaneous intracerebral hemorrhage)
  • Traumatic intracerebral hemorrhage
• Extra-axial
  • Epidural hemorrhage
  • Subdural hemorrhage
  • Subarachnoid hemorrhage (aneurysmal intracranial hemorrhage)

Maxillofacial Trauma

• Ears
  • Auricular hematoma
• Nose
  • Nasal fracture
  • Nasal septal hematoma
• Oral
  • Dental trauma
  • Lip laceration
  • Tongue laceration
• Other face
  • Le Fort fractures
  • Mandible fracture
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Related
  • Head trauma (main)
    • Skull fracture
    • Skull fracture (peds)
    • Basilar skull fracture
  • Orbital trauma
    • Eyelid laceration
  • Scalp laceration

Diagnosis

Workup

• Consider head CT (rule out intracranial hemorrhage)
  • Use validated decision rule to determine need
  • Avoid CT in patients with minor head injury who are at low risk based on validated decision rules.
• Consider cervical and/or facial CT

Management

• Monitor for increased ICP
  • HA, N/V, sz, lethargy, HTN, bradycardia, agonal respirations, posturing
• Monitor for herniation
  • Ipsilateral fixed and dilated pupil
  • Contralateral motor paralysis
• Bilateral pinpoint pupils suggests opiate use or pontine lesion

See Also

• Pediatric head trauma