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How does event happens which lead to injury? Details of exact mechanism of head injury.
Duration until reaching hospital? (may interfere management)
Site of trauma, any wounds
Complication of accident: LOC, amnesia, brain function
History of bleeding
Sign of shock: dizziness, confusion, sweating
History of otorrhea or rhinorhea (leak of CSF)
Increased ICP: blurred vision, headache, projectile vomiting
Seizure
Lateralizing signs- loss of power in the limbs or loss of sensation
History of alcohol or drugs, which may raise the risk of intracranial bleeding and cloud the
mental status assessment
History of previous head injuries or premorbid illness
iii.
iv.
*GCS is not all important in every cases except trauma, as some cases may interrupt talking or
moving i.e. tracheostomy, pseudobulbar palsy.
Physical examination
GCS
Blood behind eardrum, a post auricular hematoma (battles sign), suggest basilar skull
fracture or bilateral circum orbital hematomas (raccoon eyes)
Neurological examination
1. Higher mental function: consciousness, handedness (dominant side),orientation, GCS,
speech, calculation, memory, intellectual, thinking
2. Cranial nerve
3. Motor: inspection, palpation, reflexes (according to myotome)
4. Sensory: crude, superficial, deep, vibration, position, tactile localization & discrimination
(higher cortical)
5. Cerebellar: peripheral (limbs), truncal, cerebellum
6. Skull & spine: palpate for deformities, tenderness, limitation of movement of spine.
7. Meningism (TRO infection / inflammation following head injury): photophobia, neck stiffness,
kernigs sign, brudzinskis sign
Investigation
1. CT scan (if <13, LOC or decreasing consciousness, post traumatic seizure, lateralizing signs,
penetrating injury or skull fracture, otorrhea and rhinorrhea.
2. X-ray of injury part
3. E-FAST (to rapidly identify fluid or blood in peritoneal, pericardial or pleural space.
4. Skull X-ray: normally not help much, less indicated, only when CT scan couldnt be
performed, or in cases of gun shot, fracture, localized contusion or swelling over the head. It
shows fractures and intracranial air.
5. Lab test: PCV, urea and electrolytes, arterial blood gases, blood alcohol level. no FBC.
6. Glycemic index: at A&E, TRO unconsciousness d/t hypoglycemia.
Management
I.
II.
III.
IV.
V.
VI.
VII.
GCS full
Asymptomatic
Not on drip
Injury on other sites are well
Social factor