Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:
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- Direct skull trauma
- Inward bending of calvarium causes bleeding when dura separates from skull:
- Middle meningeal artery is involved in bleed >50% of time.
- Meningeal vein is involved in 1/3.
- Skull fracture is associated in 75% of cases, less commonly in children.
- >50% have epidural hematoma (EDH) as isolated head injury:
- Most commonly associated with subdural hematoma (SDH) and cerebral contusion
- Classic CT finding is lenticular, unilateral convexity, usually in temporal region.
- It usually does not cross suture lines, but may cross midline.
- Accounts for 1.5% of traumatic brain injury (TBI)
- Male/female incidence is 3:1.
- Peak incidence is 2nd–3rd decade of life.
- Motor vehicle accidents (MVAs), assault, and falls are most common causes:
- Of all blunt mechanisms, assault has highest association with intracranial injury requiring neurosurgical intervention.
- Uncommon in very young (<5 yr) or elderly patients
- Mortality is 12% and is related to preoperative condition.
- Head injury is the most common cause of death and acquired disability in childhood.
- Falls, pedestrian-struck bicycle accidents are most common causes:
- Most severe head injuries in children are from MVA.
- Always consider possibility of nonaccidental trauma.
- <50% have altered level of consciousness (LOC):
- If EDH in differential diagnosis (DD), CT should be obtained.
- Bleeding is more likely to be venous.
- Good outcome in 95% of children <5 yr