Head trauma (main)

Background

• Classification based on GCS
  • 14-15: Mild
  • 9-13: Moderate
  • 3-8: Severe

Diagnosis

• Monitor for increased ICP
  • HA, N/V, sz, lethargy, HTN, bradycardia, agonal respirations, posturing
• Monitor for herniation
  • Ipsilateral fixed and dilated pupil
  • Contralateral motor paralysis
• B/l pinpoint pupils suggests opiate use or pontine lesion

Workup

• Consider brain CT to rule out intracranial hemorrhage
  • Head CT in Trauma (Clinical Decision Rules)
• Consider facial/orbital CT

Differential Diagnosis

Intracranial Hemorrhage Types

• Intra-axial
  • Hemorrhagic stroke (Spontaneous intracerebral hemorrhage)
  • Traumatic intracerebral hemorrhage
• Extra-axial
  • Epidural hemorrhage
  • Subdural hemorrhage
  • Subarachnoid hemorrhage (aneurysmal intracranial hemorrhage)

Maxillofacial Trauma

• Ears
  • Auricular hematoma
• Nose
  • Nasal fracture
  • Nasal septal hematoma
• Oral
  • Dental trauma
  • Lip laceration
  • Tongue laceration
• Other face
  • Le Fort fractures
  • Mandible fracture
• Zygomatic arch fracture
• Zygomaticomaxillary (tripod) fracture
• Related
  • Head trauma (main)
    • Skull fracture
    • Skull fracture (peds)
    • Basilar skull fracture
  • Orbital trauma
    • Eyelid laceration
  • Scalp laceration

Management

• Pretreatment w/ lidocaine has not been shown to improve outcomes
• Seizure Prophylaxis in Head Trauma
• Management of Elevated Intracranial Pressure

See Also

• Pediatric head trauma