Emergency Medicine Book

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Head InjuryAka: Head Trauma

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  1. See Also
    1. Concussion in Sports
    2. Postconcussion Syndrome
  2. Pathophysiology
    1. Intracranial Pressure (ICP) association with injury
      1. Note measurements are in mmHg, not cmH2O
      2. Normal: 10 mmHg ICP
      3. Abnormal: 20 mmHg ICP
      4. Severe: 40 mmHg ICP
      5. Herniation: 50 mmHg ICP
    2. Cushing's Response
      1. Hypertensive response in face of increased ICP
      2. Helps maintain cerebral perfusion
      3. Do not use antihypertensives to lower Blood Pressure
        1. Results in decreased brain perfusion
  3. Assessment
    1. Glasgow Coma Scale
    2. Pupil exam
    3. Neurologic Exam
    4. Alcohol or drug intake history
    5. Hypotension seen in pediatric closed head injury
      1. Patrick (2002) Am J Surg 184:555
    6. Signs Skull Fracture
      1. Vault skull Fracture
      2. Basilar skull Fracture
        1. CSF Rhinorrhea or Otorrhea
        2. Hemotympanum
        3. Post-auricular bruising (Battle's Sign)
        4. Orbital bruising (Raccoon's Eyes)
        5. CN VII palsy (Bell's Palsy)
    7. Signs Intracranial Injury
      1. Focal
        1. Epidural hemorrhage
        2. Subdural hemorrhage
        3. Intracerebral hemorrhage
      2. Diffuse
        1. Mild Concussion
        2. Classic Concussion
        3. Diffuse axonal injury
  4. CT Head Indications
    1. Head CT in all cases of moderate or severe head injury
    2. Mild Head Injury Indications
      1. See Head Injury CT Indications in Adults
      2. See Head Injury CT Indications in Children
  5. Management
    1. See Management of Mild Head Injury
    2. See Management of Moderate Head Injury
    3. See Management of Severe Head Injury
    4. Avoid Systemic Corticosteroids (increases mortality)
      1. Roberts (2004) Lancet 364:1321

Craniocerebral Trauma (C0018674)

Definition (MSH)Traumatic injuries involving the cranium and intracranial structures (i.e., BRAIN; CRANIAL NERVES; MENINGES; and other structures). Injuries may be classified by whether or not the skull is penetrated (i.e., penetrating vs. nonpenetrating) or whether there is an associated hemorrhage.
ConceptsInjury or Poisoning (T037)
ICD9959.01
MSHD006259
EnglishCRANIOCEREBRAL INJ, Craniocerebral Injuries, Craniocerebral Injury, Craniocerebral Trauma, Craniocerebral Traumas, Head and Brain Injuries, HEAD INJ, Head Injuries, head injury, HEAD TRAUMA, Head Traumas, HI - Head injury, INJ CRANIOCEREBRAL, INJ HEAD, Injury of head, Injury of head region
Spanishinjuria de la cabeza, injuria de la region de la cabeza, lesion traumatica de la cabeza, traumatismo craneoencefalico
Parent ConceptsType of injury (C0449499), Other and unspecified injury to head, face, and neck (C0490041), Wounds and Injuries (C0043251), Trauma, Nervous System (C0751792), Injury (C0175677), Finding of head and neck region (C0575141), Craniocerebral Trauma (C0018674), Head and neck injury (C0178671), Duplicate concept (C1274013), Disorder of head (C1290856), Ambiguous concept (C1274012)
SourcesAOD, COSTAR, CSP, DXP, ICD9CM, MEDLINEPLUS, MSH, MTH, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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