Different hospitals have different policies on which team looks after head injuries, but the general principles remain the same. Like bruising, the burn injury pattern and location can be a red flag for abuse. CT head should also be arranged if: CT head should also be arranged if: Results for history taking head injuries 1 ... Everything NICE has said on triage, assessment, investigation and management of head injury in infants, children and adults in an interactive flowchart. Additionally, fractures of the sternum, scapula, or spinous processes are unusual in the pediatric population. When approaching a 'head injury' scenario in OSCEs, there are a few key points to be aware 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. Different hospitals have different policies on which team looks after head injuries, but the general principles remain the same. 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: In non-accidental trauma, they most commonly occur as linear fractures in the parietal bone and can often be complex in nature. The diagnosis of abusive head trauma is often missed since often no history of head trauma is provided and the signs and symptoms may be non-specific, such as vomiting, poor feeding, irritability or lethargy. A more extensive evaluation for a bleeding disorder may include fibrinogen, von Willebrand’s testing, factor deficiencies and homocysteine levels.Both a skeletal survey, which consists of a series of radiographs of the skull, thorax, long bones, hands, feet, pelvis, and spine, and a radionucleotide bone scan are tools to reveal sites of past injury. Stay signed in. by . 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 collection of history taking guides, covering common OSCE stations, to help improve your history taking skills. This is a significant amount of radiation for a child to be exposed to and thus the decision to complete a skeletal survey needs to be made carefully.If a head injury is suspected a head CT and ophthalmologic exam are important. Onset Acute Chronic (acute if < 2 – 3 months, > 3 months represents a dementing state) Progress (gradual decline, static, rate of fluctuation) Palliating; Precipitating; Quality Finding spiral fractures in the bone shaft is indicative of a twisting injury rather than a transverse fracture from direct impact. It is always important to keep an open mind and never make assumptions; yet always pay attention to subtle clues that may be present in the history and physical examination. He states that he has recently experienced moments during the day where he loses awareness for minutes at a time but soon fully recovers. Although attempts to date a bruise are inexact, finding multiple bruises of various colours on the same area may suggest they are not from a single, isolated incident.An estimated 15-25 % of pediatric burns are the result of abuse. Password . 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. A significant red flag for non-accidental injury is finding multiple fractures at various stages of healing in a child (1).Abusive head trauma, also known as shaken baby syndrome, is the most common cause of child abuse death, usually occurring during the first year of life.
Emergency medicine - How to assess and manage head injuries.
Case 3 – Amenorrhea. a 1 month old baby rolled off the couch). 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! Although there are fracture patterns suggestive of abuse, there are no patterns that are pathognomonic for non-accidental injury. During this portion of the interview it is very important to assess the parent-child interaction. Be cautious in cases where the patient is unable to recall events clearly, as this may indicate new confusion associated with a head injury.
If there is any suspicion of non-accidental injury, contact your local Child Protection Services team who will guide you through the next appropriate steps. 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.
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