Head Trauma
Summary: <br> CT scan without contrast is your test of choice.<br> <br> <br> <br> Step 1: Consider Your Differential Diagnoses<br> <br> <br> <br> * Five high-yield head trauma diagnoses* Skull fracture* External skull fracture* Basilar skull fracture* Epidural hematoma* Subdural hematoma* Traumatic subarachnoid hemorrhage (SAH)* Concussion<br> <br> <br> <br> Step 2: Important Add-ons When Taking History<br> <br> <br> <br> * Specific mechanism of injury* Loss of consciousness* Blood thinners/antiplatelet agents<br> <br> <br> <br> Step 3: Important Add-ons To Your Physical Exam<br> <br> <br> <br> * GCS Score <a href="https://www.mdcalc.com/glasgow-coma-scale-score-gcs">(MDCalc)</a>* Pupils* Basilar Skull Findings* Raccoon eyes* Battle sign* CSF rhinorrhea* Hemotympanum<br> <br> <br> <br> Step 4: Calculate Canadian Head CT Rule<br> <br> <br> <br> * 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<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Canadian CT Head Injury/Trauma Rule <a href="https://www.mdcalc.com/canadian-ct-head-injury-trauma-rule">(MDCalc)</a>* Evaluation and Management of Concussion in Sports <a href="https://www.aan.com/siteassets/home-page/tools-and-resources/practicing-neurologist--administrators/patient-resources/sports-concussion-resources/17emconcussions_tr.pdf">(AAN)</a><br>
