ED Pathway for Evaluation/Treatment of Acute Head Trauma

History and Physical

HISTORY AND SYMPTOMS

Mechanism of Injury Time
Location
Details
Loss of Consciousness Duration
Post-traumatic amnesia Duration
Post-traumatic seizure Characteristics, duration
Headache Intensity
Location
Time of onset
Analgesia use
Vomiting Time of onset
Number of episodes
Time of last episode
Dizziness Sensation of vertigo
Physical imbalance
Postural instability
Intoxication Alcohol, drugs
Pertinent Past History Developmental abnormality
Seizure disorder
Coagulopathy
Ventricular shunt

PHYSICAL EXAMINATION

Identify Life-Threatening Injury ABC’s, vital signs, Glasgow Coma Scale
Evaluation for Altered Mental Status Agitation
Somnolence
Repetitive questioning
Slow response to verbal communication
Evaluation of Scalp for Trauma
  • Bulging fontanelle in infants
  • Signs of basilar skull fracture
    • Retroaricular bruising
    • Periorbital bruising
    • Hemotympanum
    • CSF otorrhea or rhinorrhea
  • Palpable skull fracture
  • Hematoma (size, location, boggy vs. firm)
Neurologic Exam Cranial nerves
Motor, sensory exam, DTR’s
Gait
Look for Other Injury Complete physical examination (secondary survey)