How many indications are there for a CT scan in a head injury?
Seven 7
What is the mmnemonic
PASS GF >1
What does the Pass stand for
Post traumatic seizure
Amnesia > 30 minutes before impact and Age >65
Suspected open/depressed skull fracture
Signs of basal/raccoon fracture
What does GF >1 stand for?
GCS <13 at any time or < 15 2 hours post injury
Focal neurological deficit
>1 episode of vomitting
Also consider coagulopathy and dangerous mechanism of injury..
What is the management of head injury
A-E [primary survey]
- In the A immobilise the C spinr until damage is excluded
Send for bloods and radiology
Secondary survey including involving neurosurgesons, brief exam, AMPLE, BP, pulse, RR, pupils every 15 minutes, check for CSF leak,
What patients in the A management need immediate ventilation
- GCS 8 or less
- O2 on air less than 9 kpa [in air normally 21 and if you minus 10 for insensible loses should be 11 at least so 9 is too low] or less than 13 on oxygen or a co2 above 6
- Spontaneous hyperventilation
- Irregular respiration
What is management of SAH
ABCDE FeSS- ischaemic penumbra CT head Bloods FUC GC ECG If suspect, and CT- do LP and wait twelve ADMIT TO ICU FOR FREQUENT MONITORING AND MAINTAIN CEREBRAL PERFUSION Nimodipine Clipping or coil embolisation
Risks of SAH
Rebleeding, ischeamia secondary to vasospasm, hydrocephalus and hyponatraemia [brain’s response to trauma is to salt waste, and so overall low volume so fluid restriction will further dehydrate]