4 cases, 4 head injuries… August 23, 2012
Posted by Andy Jagoda, MD in: Neurologic, Radiology, Trauma , trackback
It’s 8 PM and you are just getting into the groove of your first in a series of several night shifts. After picking up your fourth head injury chart, you think to yourself, “Good grief, are we having a sale on head injury tonight?” Your patients are:
- A 16-year-old boy brought in by his parents after head-butting another player during a soccer game. He was confused for several minutes and now has a headache. His coach told his parents that he had a concussion and should go to the ER to be checked out before he can return to play.
- A 38-year-old woman who was in a low-speed motor vehicle crash. She states that she “blacked out” for a few seconds but feels fine now.
- A 2-month-old brought in by her parents with a bump on her head. They said the babysitter told them the baby rolled off the bed while she was changing her diaper.
- A well-known (to you) alcoholic brought in by the police, intoxicated, with an abrasion on his forehead. He has no idea how he hit his head and is asking for something to eat.
These are 4 cases of what appear to be minor injuries, although you know there is the chance that any of the patients may be harboring a neurosurgical lesion and that all 4 are at risk for sequelae. In your mind, you systematically go through the high-return components of the physical exam of a head-injured patient, the indications for neuroimaging in the ED, and the information needed at discharge to prepare the patients and their families for what might lie ahead. The medical student working with you is very impressed with the complexity of managing these cases, which he thought were so straightforward.
How do you handle these cases?
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