Acute Head Trauma


Step 1: View clinicals

A 22 year old man is brought in around 30 minutes after falling down from a 28 foot (8.5m) high ladder. His co-workers observed the fall, and noted that he hit the ground head-first. They also mention that he was in good health prior to the accident, and that he did not appear to be intoxicated or under the influence of drugs. At the scene of injury, his Glasgow Coma Score (GCS) was 13/15.

Step 2: Order all relevant investigations

Skull X Ray

Anteroposterior and lateral x-rays of the skull are obtained; these appear normal, with no evident fractures.

Non-contrast CT Brain

A large left-sided subdural hemorrhage (SDH) is noted. There are no features suggestive of midline shift, compression of the ventricular system, or cerebral edema. Analysis of the bone window images shows no skull fractures.

X-Ray Cervical Spine (Lateral)

The lateral x-ray of the cervical spine appears normal, with no evidence of fractures.

Chest X-Ray (AP)

The anteroposterior (AP) chest x-ray appears normal.

Step 3: Select appropriate management

Intubate stat
Neurosurgical Referral

Score: ★★☆