Head Injury
| CHQ Head Injury Guidelines |
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Workbook Questions :
Case 1
A 3-year-old boy presents to ED with his mum at 5pm after running, tripping and hitting his head on the corner of the couch. He cried immediately but has a large bump on his forehead so has been bought in for assessment.
After your history and examination you decide that there are no significant risk factors and he examines well. It is now 7pm and he is playing in the waiting room after eating an ice block.
Case 2
A 14-year-old boy was hit in the head during a tackle in a rugby game. He says he can’t remember what happened and vomited shortly after. The coach called an ambulance and on arrival to emergency he is a little drowsy and is triaged a cat 3
Case 3
A 3-month-old girl has fallen from the change table an hour before, cried straight away and seems to have been well since. She has had a breast-feed and examines well in the department.
Case 4
A 3-year-old boy presents with 6 vomits this morning. Whilst taking the history mum states he fell from the play equipment at day care yesterday morning and sustained a bruise to the back of his head.
Case 1
A 3-year-old boy presents to ED with his mum at 5pm after running, tripping and hitting his head on the corner of the couch. He cried immediately but has a large bump on his forehead so has been bought in for assessment.
- What further information would you look for in the history specific to this presentation
- What would you be looking for on examination?
After your history and examination you decide that there are no significant risk factors and he examines well. It is now 7pm and he is playing in the waiting room after eating an ice block.
- What is this child’s likely disposition? What factors would influence your decision?
- Once this child is discharged, what information are you going to give to mum and what follow up should be arranged?
Case 2
A 14-year-old boy was hit in the head during a tackle in a rugby game. He says he can’t remember what happened and vomited shortly after. The coach called an ambulance and on arrival to emergency he is a little drowsy and is triaged a cat 3
- How do you assess this child’s GCS?
- How might you decide if this child needs imaging? Are there any specific rules or criteria available? Where might you find them and what do they state?
- He has a CT that is reported as normal but is still vomiting; he is now 4 hours post the initial injury. What might you do next?
- The next day he is well and discharged home, what advice would you give to him and his family about his return to sport?
Case 3
A 3-month-old girl has fallen from the change table an hour before, cried straight away and seems to have been well since. She has had a breast-feed and examines well in the department.
- What other important considerations are there to think about in this case?
Case 4
A 3-year-old boy presents with 6 vomits this morning. Whilst taking the history mum states he fell from the play equipment at day care yesterday morning and sustained a bruise to the back of his head.
- How might you manage this child? Do you think the head injury is significant and how might you come to this conclusion?