Head Trauma

CT scan without contrast is your test of choice.











Step 1: Consider Your Differential Diagnoses











* Five high-yield head trauma diagnoses* Skull fracture* External skull fracture* Basilar skull fracture* Epidural hematoma* Subdural hematoma* Traumatic subarachnoid hemorrhage (SAH)* Concussion











Step 2: Important Add-ons When Taking History











* Specific mechanism of injury* Loss of consciousness* Blood thinners/antiplatelet agents











Step 3: Important Add-ons To Your Physical Exam











* GCS Score (MDCalc)* Pupils* Basilar Skull Findings* Raccoon eyes* Battle sign* CSF rhinorrhea* Hemotympanum











Step 4: Calculate Canadian Head CT Rule











* Only apply to patients with…* Loss of consciousness* Amnesia to event* Witnessed disorientation* Exclude patients with* Blood thinners* Seizure(s)* Age <16* High risk criteria* GCS <15 2 hours post injury* Suspected open/depressed skull fracture* Signs of basilar skull fracture* 2 or more episodes of vomiting* Age >65* “Moderate” risk criteria* Retrograde amnesia >30 minutes* Dangerous mechanism* Fall >3 ft* Motor vs pedestrian* Ejected from MVA











Additional Reading











* Canadian CT Head Injury/Trauma Rule (MDCalc)* Evaluation and Management of Concussion in Sports (AAN)