Minor Head Injury. Minor Head Injury Case 1 One year old child was playing in a swing and accidentally fell. Since the fall about 2 hours back she.

Slides:



Advertisements
Similar presentations
Implementing NICE guidance
Advertisements

HEAD AND SPINAL INJURIES
Guidelines on the early management of head injury J Kerr A&E Royal Infirmary, Edinburgh.
HEAD INJURIES Head Injuries Scalp lacerations Skull fractures Brain injuries Complications of head injuries.
Traumatic Brain Injury Presented by: David L Strauss, Ph.D. ReMed.
Head Injury Saurabh Sinha Department of Clinical Neurosciences Western General Hospital.
 10 yr old F, riding on the shoulders of another child  Held onto top of doorframe, then both children fell  Pt landed on a wooden floor  No LOC,
NICE HEAD INJURY GUIDELINES WHAT ARE THE GUIDELINES FOR THEIR INITIAL ASSESSMENT IN ED – All patients with a head injury should be assessed by an.
Mallika Khwanmuang Phatcharapol Udomluck Jitsupa Litleangdej th year medical students.
Guidelines for the Management of Minor Head Injury in Adults Società Italiana di Medicina di Emergenza-Urgenza (SIMEU) Study Group for SIMEU Guidelines.
PEDIATRIC HEAD INJURY Myra Lalas Pitt. P EDIATRIC H EAD I NJURY More than 1.5 million head injuries occur in the US annually 2M: 1F Motor vehicle collisions-
Brain Injuries in Athletics. Objectives Define and explain these terms: ◦ Concussion ◦ MTBI ◦ Second-Impact Syndrome ◦ Post-Concussion Syndrome ◦ Intracranial.
A Red Flags: 1. Progressively declining level of consciousness 2. Progressive declining neurological exam 3. Pupillary asymmetry 4. Seizures 5. Repeated.
Head injury audit Dr Ivo Dukic, Senior House Officer in Emergency Medicine Ms Caroline Plant, Staff Nurse in Emergency Medicine Dr Feroz Rahim, Staff.
Copyright restrictions may apply JAMA Pediatrics Journal Club Slides: Isolated Loss of Consciousness in Head Trauma Lee LK, Monroe D, Bachman MC, et al;
MILD TRAUMATIC BRAIN INJURY IN PATIENTS WITH VASCULAR DEMENTIA Yuri Alekseenko Department of Neurology and Neurosurgery Vitebsk Medical University Vitebsk,
An Overview of Head Injury Management Eldad J. Hadar, M.D. Department of Neurosurgery.
Traumatic Brain Injury
Traumatic Brain Injury
Traumatic Brain Injury By: Brynn and Kacy. ● Occurs when a sudden trauma causes damage to the brain, disrupting the normal functioning of the brain. ●
Dr. amal Alkhotani Frcpc neurology, epilepsy
Head Injury Psychological Services San Antonio Police Department Head Injury Psychological Services San Antonio Police Department.
Head trauma Dr.Yasir Hamandi.
Head injuries.
When is it safe to forego a CT in kids with head trauma? (based on the article: Identification of children at very low risk of clinically- important brain.
Paediatric head injury Dr Cynthia Lim July big ones CATCH CHALICE PECARN CATCH and CHALICE identify kids who need CTB PECARN identify kids who.
Closed Head Injuries in High School Athletics Kent Jason Lowry, MD Northland Orthopedic Associates.
Prevalence of Clinically Important Traumatic Brain Injuries in Children With Minor Blunt Head Trauma and Isolated Severe Injury Mechanisms Nigrovic LE,
CASE SIMULATION Debriefing. Diagnosis? Altered level of consciousness Respiratory insufficiency Acute subdural hematoma Possible inflicted traumatic brain.
Instructor Name: Title: Unit:
Traumatic Brain Injury Francisco R. Solis, MS IV St. Barnabas Hospital NYCOM-Class of 2007.
Delayed Posttraumatic Hemorrhage From (Stroke. 1995;26: ) © 1995 American Heart Association, Inc. Present by R2 Meng-Ting Wu.
Minor Head Injury in Infant and Children An Evidence Based Guide to Neuroimaging of the Young Brain Sujit Iyer, M.D. Dell Children’s Medical Center of.
Traumatic Brain Injury Dr.Shamekh M. El-Shamy. Traumatic Brain Injuries Definition: Definition: An insult to the brain, not of a degenerative or congenital.
Minor head injury. What is it? Head injury GCS >12 Adults (16-65): LOC, amnesia, confusion Kids ??
CRANIOCEREBRAL TRAUMA. Etiology/Pathophysiology HEAD INJURY Causes death or serious disability. Second most commom cause of neurological injuries. Major.
Part 4 Concussions Causes blunt force trauma to the head fall
 Shaken baby syndrome is a type of inflicted traumatic brain injury that happens when a baby is violently shaken.  A baby has weak neck muscles and.
Emergency Department Aberdeen Royal Infirmary Head Injuries in the Emergency Department August 2015.
CROSS-SECTION HEAD INJURY - DEFINITION Any injury that results in trauma to the SCALP, SKULL or BRAIN. TRAUMATIC BRAIN INJURY and HEAD INJURY are often.
Ordering CT Heads on the inpatient setting An Update of the Original Project from January 2012 Cost Containment Project DSR II June 2016 Thi Mai, PGY-2.
Why are concussions so prevalent in soccer? What can we do to prevent them from occurring in soccer? By: Jenna Madden Period: 5.
Management of Head Injuries
Minimal Traumatic brain Injury in children
CDR Implementation Trial
Approach to head trauma
ECHO DIAGNOSING CHILD MALTREATMENT: THE CHALLENGES FACED BY CLINICIANS
Lecture on Head Injuries
Trauma.
Traumatic Brain Injuries in Children
Traumatic Brain Injury
Sentinel Injuries: how to identify subtle signs of child abuse
HEAD CT DECISION RULES – WHO TO SCAN?
Supplemental Neuro PP.
Paediatric Head Injury – To CT or not CT?
CT for Minor Pediatric Head Injury
Traumatic Brain Injury
CT for Adult Minor Head Trauma
Traumatic Brain Injury (TBI)
Pre Hospital Recognition
First Aid Forward Dr. Vimal Desai
Traumatic Brain Injury TBI
Neuro-critical Transfers
Head Injury.
Neuro-critical Transfers
Head Injury Assessment & Management
Acute subdural hematoma in a high school football player requiring emergent decompressive craniectomy Christine C. Center *University of Nebraska at Omaha,
Presentation transcript:

Minor Head Injury

Case 1 One year old child was playing in a swing and accidentally fell. Since the fall about 2 hours back she has vomited twice . There is no history of seizures or LOC. There is history of bleeding from nose which stopped on its own in a couple of minutes. The family is well known to you , & bring the older sibling also to you. The only significant finding is a bruise over the occipital area. What would be your plan of action ? In India,lots of CT scans are done as parents become panicky after the fall on head,or after seeing any outside bruise or Scalp Hematoma,but sometimes do not understand the seriousness if nothing obvious from externally but scientifically we feel it is urgent?

Classification of Head Injury For AVPU and GCS Refer SOS- HOPE APP Severity Mild : GCS score 13 ~ 15 Moderate : GCS score 9 ~12 Severe : GCS score 3 ~ 8 After Analysing Glassgow coma scale it is easier to analyse the severity of Head injury,early Radiology(CT scan ) if required, please note GCS scoring is different for < 5 year old compared to older children, please read minor head injury ( word document) for GCS scoring.

Importance of CT scan Clinically important traumatic brain injury needs to be identified and scanned appropriately. It is important to not subject patients to unnecessary scans as there is a small but definite increase in the incidence of leukemia & brain tumors in children subjected to radiation of CT ( 1in 1500 ) If necessary ,CT brain is important as we can interven immediately to have less morbidity and early recovery

Indications of CT scan in TBI GCS < 14 Progressive headache Worsening level of consciousness, Definite Loss of Consciousness for more than few seconds, Focal or abnormal neurological findings, Seizure, Persistent Vomiting Penetrating skull injuries, Signs of a basal or depressed skull fracture, It is very important to see weather there is 1 single indication or multiple indication Chances of intra cranial bleed is more if more than 1 symptom is present. If 1 single episode of vomiting and no other symptoms , fall is less than 3 feet, child is conscious, then may be worth waiting

Do not perform CT scan in… Low-risk patients should meet all of the following criteria Normal mental status No parietal, occipital or temporal scalp hematoma No loss of consciousness >5 seconds No evidence of skull fracture Normal behavior according to the routine caregiver No high-risk mechanism of injury High Risk Mechanisms: fall >0.9 m [3 feet]; head struck by high impact object; motor vehicle collision with patient ejection, death of another passenger, or rollover; pedestrian or bicyclist without helmet struck by a motorized vehicle) The risk for clinically important traumatic brain injury is less than 0.02 percent in these patients

Historical features that may suggest an increased risk of brain injury Child younger than two years of age is not acting normally Seizure, confusion, or loss of consciousness ( > 5 seconds ) Severe or worsening headache Vomiting > 2 times after fall High-risk mechanism, such as a fall from greater than 3 to 5 feet , significant motor vehicle collision, penetrating injury, inflicted injury, or unwitnessed fall Pre-existing conditions that place the child at risk for intracranial hemorrhage, such as arterio-venous malformation or a bleeding disorder Concerns about non accidental trauma we follow standard guidelines then we can assure parents about its necessity can be explained The probability of clinically important TBI ( ciTBI ) as determined by clinical findings is a key factor for identifying the optimal approach in individual patients. Patients at high risk for ciTBI should undergo prompt neuroimaging. Those at intermediate risk may undergo neuroimaging or observation with performance of imaging if persistent, worsening or new symptoms occur during observation. Infants and children at low risk for ciTBI should not undergo neuroimaging. Clinical decision rules can assist the clinician in determining the level of risk and need for neuroimaging but should not replace clinical judgment

Physical findings that may suggest an increased risk of brain injury Scalp abnormalities, such as hematoma> 3cm in non frontal area , tenderness, or depression In infants, bulging anterior fontanel Abnormal mental status Focal neurologic abnormality Signs of basilar skull fracture These signs can early detect raised IC pressure before the complications occur

Disposition Perform neuroimaging in all patients with high risk signs or symptoms Observe for 4-6 hours in all others. Observation can be done at home by a compliant care giver or in the ER /Clinic No role for X-ray of skull Old concepts of X-ray skull does not help any way, High risk patients early hematoma, or intra-ventricular hemorrhage can save a life and prevent morbidity While observation being done at home , please educate parents about what symptoms to observe and where to contact in case of emergency.