Head Trauma


Article Author:
Faizan Shaikh


Article Editor:
Muhammad Waseem


Editors In Chief:
David Wood
Andrew Wilt
Hajira Basit


Managing Editors:
Avais Raja
Orawan Chaigasame
Khalid Alsayouri
Kyle Blair
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Abbey Smiley
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beenish Sohail
Hajira Basit
Phillip Hynes
Sandeep Sekhon


Updated:
11/15/2018 11:19:57 PM

Introduction

Traumatic brain injury (TBI) is a common presentation in emergency departments, which accounts for more than one million visits annually. It is a common cause of death and disability among children and adults.[1]

Based on the Glasgow Coma Scale (GCS) score, it is classified as:

  • Mild = GCS 14 to 15, also called concussion
  • Moderate = GCS 9 to 13
  • Severe = GCS 3 to 8

Etiology

The leading causes of head trauma are (1) motor vehicle-related injuries, (2) falls, and (3) Assaults.[2][3]

Based on the mechanism, head trauma is classified as (1) blunt (most common mechanism), (2) penetrating (most fatal injuries), (3) blast.

 Most severe TBIs result from motor vehicle collisions and falls.

Epidemiology

Head trauma is more common in children, adults up to 24 years, and those older than 75 years.[4][5][6]

TBI is 3 times more common in males than females.

Although only 10% of TBI occurs in the elderly population, it accounts for up to 50% of TBI-related deaths.

Pathophysiology

The following concepts are involved in the regulation of blood flow and should be considered.

1) Monroe-Kellie Doctrine

  • Related to the understanding of intracranial pressure (ICP) dynamics.
  • Any individual component of the intracranial vault may undergo alterations, but the total volume of intracranial contents remains constant since the space within the skull is fixed. In other words, the brain has a compensatory mechanism to maintain an equilibrium thereby maintaining normal intracranial pressure. 
  • According to this, displacement of cerebrospinal fluid (CSF) or blood occurs to maintain normal ICP. A rise in ICP will occur when the compensatory mechanisms are exhausted.

2) Regulation of Cerebral Blood Flow (CBF) (Autoregulation)

  • Under normal circumstances, the brain maintains CBF via auto-regulation which maintains equilibrium between oxygen delivery and metabolism.
  • Autoregulation adjusts Cerebral perfusion pressure (CPP) from 50 to 150 mm Hg. Beyond this range, autoregulation is lost, and blood flow is only dependent on blood pressure.
  • Severe brain injury may disrupt autoregulation of CBF.

3) Cerebral Perfusion Pressure (CPP)

  • The difference between the mean arterial pressure (MAP) and the ICP (CPP = MAP – ICP)
  • Target CPP is 55 mm Hg  to 60 mm Hg 
  • An increase in ICP can decrease the CPP
  • A decrease in ICP may improve CPP
  • Remember, lowering MAP in a hypotensive patient may lower CPP.
  • A minimum CPP should be maintained to avoid cerebral insult. It is age-dependent and is as follows: Infants - 50 mm Hg, Children - 60 mm Hg, and Adults - 70 mm Hg.
  • CBF is quite sensitive to oxygen and carbon dioxide.
  • Hypoxia causes vasodilation and therefore increases CBF and may worsen ICP.
  • Hypercarbia also results in vasodilation and can alter ICP via effects on CSF pH and increases CBF.

4) Mean arterial pressure (MAP)

  • Maintain = 80 mm Hg 
  • 60 mm Hg = cerebral vessels maximally dilated 
  • < 60 mm Hg = cerebral ischemia 
  • > 150mmHg =  increased ICP

5) Intracranial pressure (ICP)

  • An increase in ICP can decrease the CPP.
  • ICP is dependent on the volume of the following compartments:
  • Brain parenchyma (< 1300 mL)
  • Cerebrospinal fluid (100 - 150 mL)
  • Intravascular blood (100 - 150 mL)
  • Cushing reflex (hypertension, bradycardia, and respiratory irregularity) due to an increase in ICP
  • Normal ICP is age dependent (adult younger than ten years old, child 3-7 years old, infant 1.5-6 years old)
  • > 20 mm Hg= increased morbidity and mortality and should be treated. It is perhaps more important to maintain an adequate CPP.

TBI can be classified as primary injury and secondary injury:

Primary Injury

Primary injury includes injury upon initial impact that causes displacement of the brain due to direct impact, rapid acceleration-deceleration, or penetration. These injuries may cause contusions, hematomas, or axonal injuries.

  • Contusion (bruise on the brain parenchyma)
  • Hematoma (subdural, epidural, intraparenchymal, intraventricular, and subarachnoid)
  • Diffuse axonal injury (stress or damage to axons)

Secondary Injury/Secondary Neurotoxic Cascade

Secondary injury consists of the changes that occur after the initial insult. It can be due to:

  • Systemic hypotension
  • Hypoxia
  • Increase in ICP

After a primary brain injury, a cascade of cellular and biochemical events occurs which include the release of glutamate into the presynaptic space resulting in activation of N-methyl-D-aspartate, a-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid, and other receptors. This ionic shift may activate cytoplasmic and nuclear enzymes, resulting in mitochondrial damage, and cell death and necrosis.

Brain Herniation

Herniation occurs due to increased ICP. Following are the types of herniations.

1) Uncal transtentorial

  • The uncus is the most medial portion of the hemisphere, and the first structure to shift below the tentorium.
  • Compression of parasympathetic fibers running with the third cranial nerve
  • Ipsilateral fixed and dilated pupil with contralateral hemiparesis

2) Central transtentorial

  • Midline lesions, such as lesions of the frontal or occipital lobes or vertex
  • Bilateral pinpoint pupils, bilateral Babinski signs, and increased muscle tone. Fixed midpoint pupils follow along with prolonged hyperventilation and decorticate posturing

3) Cerebellar tonsillar

  • Cerebellar tonsils herniate in a downward direction through the foramen magnum
  • Compression on the lower brainstem and upper cervical spinal cord
  • Pinpoint pupils, flaccid paralysis, and sudden death

4) Upward posterior fossa/cerebellar herniation

  • Cerebellum is displaced in an upward direction through the tentorial opening
  • Conjugate downward gaze with absence of vertical eye movements and pinpoint pupils

History and Physical

A good history concerning the mechanism of injury is important. Follow trauma life support protocol and perform primary, secondary, and tertiary surveys. Once the patient is stabilized, a neurologic examination should be conducted. CT scan is the diagnostic modality of choice in the initial evaluation of patients with head trauma.

Evaluation

CT scan is required in patients with head trauma

  • Moderate (GCS score 9 to 12)
  • Severe (GCS score < 8)

For patients who are at low risk for intracranial injuries, there are two externally validated rules for when to obtain a head CT scan after TBI.[7][8]

It is important to understand that no individual history and physical examination finding can eliminate the possibility of intracranial injury in head trauma patients.

New Orleans Criteria

  • Headache
  • Vomiting (any)
  • Age > 60 years
  • Drug or alcohol intoxication
  • Seizure
  • Trauma visible above clavicles
  • Short-term memory deficits

Canadian CT Head Rule

  • Dangerous mechanism of injury
  • Vomiting = two times
  • Age > 65 years
  • GCS score < 15, 2-hours post-injury
  • Any sign of basal skull fracture
  • Possible open or depressed skull fracture
  • Amnesia for events 30 minutes before injury

Level A Recommendation

With the loss of consciousness or posttraumatic amnesia only if one or more of the following symptoms are present:

  • Headache
  • Vomiting
  • Age > 60 years
  • Drug or alcohol intoxication
  • Deficits in short-term memory
  • Physical findings suggestive of trauma above the clavicle
  • Posttraumatic seizure
  • GCS score < 15
  • Focal neurologic deficit
  • Coagulopathy

Level B Recommendation

Without loss of consciousness or posttraumatic amnesia if one of the following specific symptoms presents:

  • Focal neurologic deficit
  • Vomiting
  • Severe headache
  • Age > 65 years
  • Physical signs of a basilar skull fracture
  • GCS score < 15
  • Coagulopathy
  • Dangerous mechanism of injury
  • Ejection from a motor vehicle (such as Pedestrian struck or a fall from a height > three feet or five stairs)

The risk of intracranial injury when clinical decision rule results are negative is less than 1%.

For children, Pediatric Emergency Care Applied Research Network (PECARN) decision rules exist to rule out the presence of clinically important traumatic brain injuries. However, this rule applies only to children with GCS > 14.

Treatment / Management

The most important goal is to prevent secondary brain injuries. This can be achieved by the following:

  • Maintain airway and ventilation
  • Maintain cerebral perfusion pressure
  • Prevent secondary injuries (by recognizing and treating hypoxia, hypercapnia, or hypoperfusion)
  • Evaluate and manage for increased ICP
  • Obtain urgent neurosurgical consultation for intracranial mass lesions
  • Identify and treat other life-threatening injuries or conditions (if they exist)

A relatively higher systemic blood pressure is needed:

  • Increase in intracranial pressure
  • Loss of autoregulation of cerebral circulation

Priorities remain the same:  the ABC also applies to TBI. The purpose is to optimize perfusion and oxygenation.[1][9][10]

Airway and Breathing

Identify any condition which might compromise airway, such as pneumothorax.

For sedation, consider using short-acting agents having minimal effect on blood pressure or ICP:

  • Induction agents:  Etomidate or propofol
  • Paralytic agents: Succinylcholine or Rocuronium

Consider endotracheal intubation in the following situations:

  • Inadequate ventilation or gas exchange such as hypercarbia, hypoxia, or apnea
  • Severe injury (GCS score of = 8)
  • Inability to protect airway
  • Agitated patient
  • Need for patient transport

The cervical spine should be maintained in-line during intubation.

Nasotracheal intubation should be avoided in patients with facial trauma or basilar skull fracture.

Targets:             

  • Oxygen saturation > 90
  • PaO2 > 60
  • PCO at 35 - 45

Circulation

Avoid hypotension. A normal blood pressure may not be adequate to maintain adequate flow and CPP if ICP is elevated.

Target

  • Systolic blood pressure > 90 mm Hg
  • MAP > 80 mm Hg

Isolated head trauma usually does not cause hypotension. Look for another cause if the patient is in shock. 

Increased ICP

Increased ICP can occur in head trauma patients resulting in the mass occupying lesion. Utilize a team approach to manage impending herniation.

Signs and symptoms:

  • Change in mental status
  • Irregular pupils
  • Focal neurologic finding
  • Posturing: decerebrate or decorticate
  • Papilledema (may not be apparent with rapid elevation of ICP)

CT scan findings:

  • Attenuation of sulci and gyri
  • Poor gray/white matter demarcation

General Measures

Head Position: Raise the head of the bed and maintain the head in midline position at 30 degrees: potential to improve cerebral blood flow by improving cerebral venous drainage.

Lower cerebral blood volume (CBV) can lower ICP. 

Temperature Control: Fever should be avoided as it increases cerebral metabolic demand and affects ICP.

Seizure prophylaxis: Seizures should be avoided as they can also worsen CNS injury by increasing the metabolic requirement and may potentially increase ICP. Consider administering fosphenytoin at a loading dose of 20mg/kg.

Only use an anticonvulsant when it is necessary, as it may inhibit brain recovery.

Fluid management: The goal is to achieve euvolemia. This will help to maintain adequate cerebral perfusion. Hypovolemia in head trauma patients is harmful. Isotonic fluid such as normal saline or Ringer Lactate should be used. Also, avoid hypotonic fluid.

Sedation: Consider sedation as agitation and muscular activity may increase ICP.

  • Fentanyl: Safe in intubated patients 
  • Propofol: A short-acting agent with good sedative properties, potential to lower ICP, possible risk of hypotension and fatal acidosis
  • Versed: sedative, anxiolytic, possible hypotension
  • Ketamine: Avoid as it may increase ICP. 
  • Muscle relaxants: Vecuronium or Rocuronium are best options for intubation; Succinylcholine should not be used as ICP may rise with fasciculations.

 ICP monitoring: 

  • Severe head injury
  • Moderate head injury with increased risk factors such as abnormal CT scan finding
  • Patients who cannot be evaluated with serial neurological examination 

Hyperventilation:

Normocarbia is desired in most head trauma patients. The goal is to maintain PaCO between 35-45 mmHg. Judicious hyperventilation helps to reduce PaCO2 and causes cerebral vasoconstriction. Beware that, if extreme, it may reduce CPP to the point that exacerbation of secondary brain injury may occur. Avoid hypercarbia: PaCO > 45 may cause vasodilatation and increases ICP. 

Mannitol:

A potent osmotic diuretic with net intravascular volume loss

Reduces ICP and improves cerebral blood flow, CPP, and brain metabolism

Expands plasma volume and can improve oxygen-carrying capacity

Onset of action is within 30 minutes

Duration of action is from two to eight hours

Dose is 0.25-1 g/kg (maximum: 4 g/kg/day)

Avoid serum sodium > 145 m Eq/L

  • Serum sodium > 145 m Eq/L
  • Serum osmolality > 315 mOsm

Relative contraindication:  hypotension does not lower ICP in hypovolemic patients.

Hypertonic saline:

May be used in hypotensive patients or patients who are not adequately resuscitated.

Dose is 250 mL over 30 minutes.

Serum osmolality and serum sodium should be monitored.

Mild Head Trauma

The majority of head trauma is mild. These patients can be discharged following a normal neurological examination as there is minimal risk of developing an intracranial lesion.

Consider observing at least 4 to 6 hours if no imaging was obtained.

Consider hospitalization if these other risk factors are present:

  • Bleeding disorder
  • Patient taking anticoagulation therapy or antiplatelet therapy
  • Previous neurosurgical procedure 

Provide strict return precautions for patients discharged without imaging.

Pearls and Other Issues

Hyperglycemia may worsen the outcome.

An elevated temperature may increase ICP and worsen outcome.

  • Increase metabolic demand
  • Increase glutamate release

A prolonged seizure may worsen secondary brain injuries.

Enhancing Healthcare Team Outcomes

Head trauma is a major public health problem accounting for thousands of admissions each year and costing the healthcare system billions of dollars. The majority of patients with head trauma are seen in the emergency department and is often associated with other organ injuries as well. The care of a patient with head trauma is an interprofessional as almost every organ system is affected. Most patients require admission and monitoring in an ICU setting. The outcome of these patients depends on the severity of the head trauma, initial GCS score, and any other organ injury. Data indicates that those patients with an initial GCS of 8 or less have a mortality rate of 30% within 2 weeks of the injury. Other negative prognostic factors include advanced age, elevated intracranial pressure, and presence of a gross neurologic deficit on presentation. Patients with a GCS less than 9 often require mechanical ventilation, tracheostomy, and a feeding tube. With prolonged hospital stay, there are prone to pressure ulcers, aspiration, sepsis, failure to thrive and deep vein thrombus. Recovery in most patients can take months or even years. Even those who are discharged often have residual deficits in executive function or neurological deficits. Despite education of the public, many young people still lead a lifestyle that predisposes them to head injury. Young people still drink and drive, text while driving, abuse alcohol and illicit drugs, and are often involved in high-risk sporting activities, which makes them susceptible to head trauma.[11][12]


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Head Trauma - Questions

Take a quiz of the questions on this article.

Take Quiz
Which of the following head trauma patients requires surgery?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which is not a complication of head trauma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following does not increase intracranial pressure (ICP) after head trauma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
In a patient with head trauma, which of the following does not indicate rising intracranial pressure?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A head trauma patient presents with a 13 Glasgow coma scale score. The pupils are equal and reactive, and hemodynamics are stable. Two hours later the blood pressure is 185/105 mmHg and the left pupil is large. Which treatment is most necessary?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A head CT is not warranted in an individual with which of the following findings after head trauma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following trauma patients would not require a CT scan of the head?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 17-year-old is thrown off his motorbike and brought to the emergency room alert. His vital signs appear intact, but he is moaning and complaining of pain in his left neck. He becomes drowsy and examination reveals a dilated left pupil. There is a clear fluid coming out of the left ear. He also has a light nosebleed and a large scalp laceration. His blood pressure is 110/80 mmHg, respiration rate is 8 breaths per minute, and pulse is 145 beats per minute. The rest of the exam is unremarkable. What test will you perform to determine that the fluid in the ear is not from the brain?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which is not a factor for poor outcome in patients with head trauma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following patients with head trauma does not require admission?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following scenarios does not necessitate a head CT after head trauma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is not associated with a poor outcome after head trauma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient is involved in a motorbike accident and has severe head trauma. A CT scan reveals swelling of the brain with diffuse bleeding. He has a Glasgow coma score of 10. It is decided to treat this patient conservatively with supportive care. What drug can make the patient's condition worse?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
After closed head trauma, a CT scan is NOT warranted in an individual with which of the following?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient's ICP is being monitored in the neurosurgical ICU due to a closed head injury. His ICP measurements suddenly start to rise. An acute increase in ICP is characterized by which of the following clinical findings?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
After head trauma, a CT scan is warranted in an individual with which of the following?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following cases does not require immediate neurosurgical consultation?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient is robbed and is knocked unconscious for several minutes from a blow to his head. Other than a mild headache, he is otherwise fine and returns home. The following day he is found to be unresponsive by his wife, but by the time the ambulance arrives, he regains consciousness. He is alert but has a slight right-sided weakness. Which is the most likely diagnosis?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient develops a severe concussion with brain edema causing cerebral artery compression. The patient's respiratory drive is diminished and he requires mechanical ventilation. Which of the following caused the decreased respiratory drive?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A young male is thrown off his motorbike after being hit by a car. He loses consciosuness for a few minutes but regains consciosuness and is lethargic. He is brought to the ER by EMS and is found to have a GCS of 7 with bilateral dilated pupils. It is decided to intubate him immediately and then get the imaging studies. What should be avoided in this patient following intubation?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
In which situation is an urgent brain CT scan not indicated?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A provider is examining a patient who sustained a severe traumatic head injury. He documents no Doll's eyes. What does this signify?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient suffered a significant head trauma. He complains of double vision worsened when looking to the left. Examination reveals a palsy of which cranial nerve?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Select the true statement about head trauma and hematomas



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is the leading cause of disability and death in football play?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which may be present in severe head injury?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Why would a patient with a head injury be instructed to avoid the valsalva maneuver?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Head Trauma - References

References

Brommeland T,Helseth E,Aarhus M,Moen KG,Dyrskog S,Bergholt B,Olivecrona Z,Jeppesen E, Best practice guidelines for blunt cerebrovascular injury (BCVI). Scandinavian journal of trauma, resuscitation and emergency medicine. 2018 Oct 29     [PubMed]
Portaro S,Naro A,Cimino V,Maresca G,Corallo F,Morabito R,Calabrò RS, Risk factors of transient global amnesia: Three case reports. Medicine. 2018 Oct     [PubMed]
Salehpour F,Bazzazi AM,Aghazadeh J,Hasanloei AV,Pasban K,Mirzaei F,Naseri Alavi SA, What do You Expect from Patients with Severe Head Trauma? Asian journal of neurosurgery. 2018 Jul-Sep     [PubMed]
Mohammadifard M,Ghaemi K,Hanif H,Sharifzadeh G,Haghparast M, Marshall and Rotterdam Computed Tomography scores in predicting early deaths after brain trauma. European journal of translational myology. 2018 Jul 10     [PubMed]
Lalwani S,Hasan F,Khurana S,Mathur P, Epidemiological trends of fatal pediatric trauma: A single-center study. Medicine. 2018 Sep     [PubMed]
Schneider ALC,Wang D,Ling G,Gottesman RF,Selvin E, Prevalence of Self-Reported Head Injury in the United States. The New England journal of medicine. 2018 Sep 20     [PubMed]
Pavlović T,Milošević M,Trtica S,Budinčević H, Value of Head CT Scan in the Emergency Department in Patients with Vertigo without Focal Neurological Abnormalities. Open access Macedonian journal of medical sciences. 2018 Sep 25     [PubMed]
Hajiaghamemar M,Lan IS,Christian CW,Coats B,Margulies SS, Infant skull fracture risk for low height falls. International journal of legal medicine. 2018 Sep 7     [PubMed]
Jacquet C,Boetto S,Sevely A,Sol JC,Chaix Y,Cheuret E, Monitoring Criteria of Intracranial Lesions in Children Post Mild or Moderate Head Trauma. Neuropediatrics. 2018 Sep 17     [PubMed]
Bayley MT,Lamontagne ME,Kua A,Marshall S,Marier-Deschênes P,Allaire AS,Kagan C,Truchon C,Janzen S,Teasell R,Swaine B, Unique Features of the INESSS-ONF Rehabilitation Guidelines for Moderate to Severe Traumatic Brain Injury: Responding to Users' Needs. The Journal of head trauma rehabilitation. 2018 Sep/Oct     [PubMed]
Fitzpatrick S,Leach P, Neurosurgical aspects of abusive head trauma management in children: a review for the training neurosurgeon. British journal of neurosurgery. 2018 Oct 24     [PubMed]
Hussain E, Traumatic Brain Injury in the Pediatric Intensive Care Unit. Pediatric annals. 2018 Jul 1     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Pediatrics-Medical Student. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Pediatrics-Medical Student, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Pediatrics-Medical Student, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Pediatrics-Medical Student. When it is time for the Pediatrics-Medical Student board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Pediatrics-Medical Student.