Head trauma (adult)

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 present):

1) Short term memory deficit ( >amnesia to the event; i.e. persistent anterograde amnesia)

2) Evidence of trauma above clavicles (signs of linear, basilar, depressed skull fracture, scalp hematoma, soft-tissue injury)

3) Headache

4) Vomiting

5) Age >60yrs

6) Drug or EtOH intoxication (by suspicion, not nec lab tests)

7) Seizure post trauma

(NEJM 7/00, Haydel)

CANADIAN HEAD CT RULE

Minor head trauma = witnessed LOC, definite amnesia, witnessed disorientation w/ GCS 13-15

CT indicated for (if any present):

A. High Risk (for neurological intervention)

    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

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.)

1. DAI

2. Contusion

3. Epidural

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)

1. ABCs

2. HOB Elevated

3. Sx Prophy (see other)

    Dilantin 13-18mg/kg IV over 20min

4. CO2

    (PCo2 30-35 if sx herniation)

5. Prevent

    -Hypotension

    -Hypoxia

    -Anemia

    -Hyperthermia

    -Coagulopathy

(Lancet 5/01, Stiell)

2/6/06 DONALDSON (adapted from Lampe)

Authors: