I'd go along with all of the answers you've already received Jel, i.e.
observe only; in hospital if family are apprehensive or live far away or if
late at night; at home if family sensible, live not too far away and
daylight hours (families can't be expected to observe while they and the
patient sleep!).
With respect to guidelines, in the old days I relied upon the tomes of
Jennett and Teasdale, who did remarkable work on this subject in the 1970s
and 1980s, including, of course, development of the Glasgow Coma Scale.
Although I now prefer to use more up-to-date resources, I still hark back to
these Celtic roots, where there continues to be a huge interest in trauma
among neurosurgeons. The Scottish Intercollegiate Guidelines Network (SIGN)
has some very useful and comprehensive guidelines on-line, all easily
downloadable and printable, and backed up by the relevant evidence base.
They can be found at http://www.sign.ac.uk/
These guidelines do take into account such practical issues as ease of
access to CT etc, and judging from your email source (Pacific Time?) you
will have to tailor these guidelines to the particular exigencies of your
situation!
Regards
Adrian Fogarty
----- Original Message -----
From: "Jel Coward" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, December 20, 2002 8:39 AM
Subject: Head injury guidelines
> Hi all
>
> On the scrounge
>
> Are their any guidelines generally accepted for the management of head
> injuries. In particular, who gets a CT now, who gets observed etc?
>
> I received conflicting opinions recently, and am working in a foreign
> land - so I am not sure what is international/individual variation
>
> Briefly the story was a 20 year old fit, well and sober male who fell
> down 4 steps and landed head first, somersaulted and hit head again.
> Loss of consciousness for about 40 seconds then awoke and got up . Was
> unsteady for a few seconds and then ok. He had struck both sides of his
> forehead (contusion, no clinically apparent #). He had a
> bifrontal/retroorbital headache rated at 8/10, was nauseous but hadnt
> vomited when seen 4 hours post injury. The symptoms were static at this
> stage and he complained of nothing else. He had no other injuries and
> had been driven in by his father. Physical exam was otherwise
> unremarkable. One colleague said CT, one said observe. Luckily for me
> I could do neither but it was a question of which institution he be
> transported to
>
> TIA
>
> Cheers
> --
> Jel Coward
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