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Acute Head Injury: When to Image and When to Observe?

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Neurologic Emergencies

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Abstract

A 21-year-old male presents to the emergency department (ED) via ambulance after being struck by a car while riding a scooter without a helmet. Per the paramedic, patient had LOC on scene. He was complaining of right ear and right-sided head pain but denied neck, back, extremity, or abdominal pain. Though he could answer some questions, others were answered inappropriately, and he was unreliable in following commands. The paramedics placed him in a C-collar and on a backboard and noted fluid draining from the patient’s right ear. His initial GCS was 13 for confusion and localizing pain. His arrival vital signs were: blood pressure 138/82, HR 112, RR 18, 96% on 2 L, and temperature 37.8 C. He had symmetric breath sounds and 2+ femoral and DP pulses. Pupils were equal and reactive; he had right hemotympanum and abrasions to the head and face. His abdomen was soft and non-tender, and he had multiple abrasions on the extremities and a contusion to his right flank.

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Authors and Affiliations

  1. University of Central Florida, Osceola Regional Medical Center, Kissimmee, FL., USA

    Tracy MacIntosh M.D., M.P.H.

  2. University of Central Florida College of Medicine, Orlando, FL, USA

    Adam Benzing M.D., M.P.H

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  1. Tracy MacIntosh M.D., M.P.H.
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Correspondence to Tracy MacIntosh M.D., M.P.H. .

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  1. Orlando, Florida, USA

    Latha Ganti

  2. Boston, Massachusetts, USA

    Joshua N. Goldstein

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MacIntosh, T., Benzing, A. (2018). Acute Head Injury: When to Image and When to Observe?. In: Ganti, L., Goldstein, J. (eds) Neurologic Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-319-64523-0_3

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