Tim Milligan November 16, 2015 Neurology.
History. More: Guidance. Headache is however also associated with a number of serious conditions and therefore it is essential you are able to take a comprehensive headache history and identify red flags that indicate the need for further investigation. Onset Acute Chronic (acute if < 2 – 3 months, > 3 months represents a dementing state) Progress (gradual decline, static, rate of fluctuation) Palliating; Precipitating; Quality Unusual sites for bruising which are suspicious for non-accidental trauma include: the buttocks, trunk, genitals, ears, and back of hands. Evidence of poor caretaking, sudden onset of mental status changes, any bruises on an infant that is not cruising yet, bruises to the pinna, neck or abdomen and any injury to the genitalia.
Often occurs due to a FOOSH (fall on outstretched hand), or a crush injury; Patient complains of wrist pain – usually radial, and worse with movement; Physical Exam. Different hospitals have different policies on which team looks after head injuries, but the general principles remain the same.
intellectually disabled).
Additionally, immersion scalds of the hands, feet, or buttocks can occur if a child is placed in hot water intentionally or unintentionally.Fractures are the second most common manifestation of child abuse after soft tissue injuries. A skeletal survey may also be repeat 7 – 10 days following the injury to reveal healing fractures that may have been missed. Take a focused history of this complaint. www.osce-aid.co.uk Head injury is a common presentation to A&E departments. It is important to keep in mind that some findings may be concerning initially but are actually not signs of intentional injury. Although there are fracture patterns suggestive of abuse, there are no patterns that are pathognomonic for non-accidental injury. Dr Clare Hammell. Femur fractures prior to the age of walking are especially concerning, as are bilateral long-bone fractures. Intense crying, coughing or retching may cause petechiae on the face and shoulders, Mongolian spots may appear as bruising in the lumbosacral area, coagulopathies may result in usual bruising, and pathologic bone disease (e.g. Non-accidental injuries should be suspected when an injury is unexplained, the severity of the injury is incompatible with the history, the history keeps changing, or the injury is inconsistent with the developmental age of the child.
Be cautious in cases where the patient is unable to recall events clearly, as this may indicate new confusion associated with a head injury. A detailed history is essential in determining the cause of falls.
If the injury does not warrant admission or treatment (see NICE guidelines), then the patient could be sent home with the following advice: After initial management monitor patient with regular neurological observations - any drop in GCS may warrant CT head. In all cases of bruising, screening tests for a bleeding diathesis should be performed with CBC, INR, and PTT. Different hospitals have different policies on which team looks after head injuries, but the general principles remain the same. If the injury does not warrant admission or treatment (see NICE guidelines), then the patient could be sent home with the following advice: Emergency medicine - How to assess and manage head injuries. History Following Head Injury If the patient is conscious, has been adequately resuscitated, and does not require immediate imaging or intervention, it would be appropriate to try and take a brief history.
Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management.A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Consider Cervical Spine imaging (see NICE guidelines)If there is persistently low GCS, ongoing confusion, abnormalities on head/spine imaging or concerns on examination, then discuss with neurosurgical centreConsider admitting to monitor, or discharge home if low risk and accompanied by responsible adult (see NICE guidelines for further details)Urgent (<1 hour) CT head should be obtained where possible for patients with: Concerning information during history taking is if the injury is not well explained, the severity does not match with the history, or the injury is inconsistent with the developmental age (e.g. Traumatic – post head injury Drug induced – aminoglycosides Characteristics (points to ask on history) – adapted from Tintinalli’s Emergency Medicine: A Comprehensive Guide ’04
Shaking or blunt head trauma can result in cranial injuries such as unilateral or bilateral subdural hemorrhage, diffuse retinal hemorrhage, and diffuse brain injury. Any delay is seeking medical care following an injury is also suspicious for abuse. Indications for a skeletal survey are any child less than 2 years of age with any evidence of abuse, any child less than 5 years of age with a suspicious fracture, or any older child who is unable to communicate areas of pain or trauma (e.g.
Finally, always remember to document thoroughly and accurately.Edited by: Anne Marie Jekyll, MD (Pediatric Resident)Last updated on September 20, 2011 @2:33 pm
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