CT Head Guidelines

Question 1

What is the key investigation in head injury?

Answer 1

CT head

Question 2

When should a CT head be done within 1 hour of presentation?

Answer 2

• GCS of 12 or less on initial assessment in the Emergency Department
• GCS less than 15 two hours after injury
• Suspected open or depressed skull fracture
• Signs of basal skull fracture
• New focal neurology
• More than 1 episode of vomiting
• Post-traumatic seizure

Question 3

What are the criteria for performing a CT head within 8 hours of injury?

Answer 3

• Loss of consciousness or amnesia
• Aged 65 or older
• Bleeding or clotting disorder
• Dangerous mechanism of injury
• More than 30 minutes of amnesia for events prior to the injury

Question 4

Fill in the blank: CT head should be done within 1 hour if presenting later than ______.

Answer 4

8 hours

Question 5

What additional considerations should be made for patients on anticoagulant or antiplatelet medications?

Answer 5

Consider a CT head within 8 hours

Question 6

What bedside tests are recommended for head trauma evaluations?

Answer 6

• Capillary blood glucose
• Blood gas
• ECG
• Toxicology screen

Question 7

What blood tests are important in the management of head trauma?

Answer 7

• Full blood count
• U&Es and LFTs
• Coagulation screen
• Group and save +/- crossmatch

Question 8

What other imaging may be warranted for suspected injuries?

Answer 8

• Chest X-ray for traumatic pneumothorax
• MRI head for ongoing clinical suspicions

Question 9

What are the three management categories for head trauma?

Answer 9

• Conservative
• Medical
• Surgical

Question 10

What is the management protocol for patients with mild head injuries and a GCS of 15?

Answer 10

Managed in the community with observation for 24 hours

Question 11

When is intubation and ventilation required in head trauma management?

Answer 11

In patients with a GCS of 8 or less or irregular breathing

Question 12

What is the role of analgesia in medical management of head trauma?

Answer 12

Helps with raised intracranial pressure

Question 13

What should be monitored and treated in medical management of head trauma?

Answer 13

Intracranial pressure

Question 14

When should neurosurgery be consulted in head trauma cases?

Answer 14

• Significant injuries identified on CT head
• GCS less than 8 despite resuscitation
• Deterioration in GCS as an inpatient
• Progressive focal neurology
• Seizure without full recovery
• Penetrating injury
• Cerebrospinal fluid leak
• Unexplained confusion for over 4 hours

Question 15

What are potential complications of head trauma?

Answer 15

• Herniation
• Hypopituitarism
• Post-traumatic seizures
• Permanent neurological deficits
• Mental health problems
• Cognitive impairment

Question 16

What does ‘coning’ refer to in the context of head trauma?

Answer 16

Herniation of the cerebellar tonsils through the foramen magnum

Question 17

True or False: Hypopituitarism occurs in 33-50% of people with traumatic brain injuries.

Answer 17

True

Question 18

What are common permanent neurological deficits after traumatic brain injury?

Answer 18

• Weakness
• Spasticity
• Contractures
• Dysarthria
• Dysphasia

Question 19

What mental health problems are common after traumatic brain injuries?

Answer 19

• Depression
• Anxiety
• Post-traumatic stress disorder

Question 20

What cognitive impairments may occur after traumatic brain injury?

Answer 20

• Memory difficulties
• Concentration issues
• Language challenges
• Planning difficulties
• Disinhibition

Question 21

What is the intial management for C-spine injury once spine has been secured in a snoring patient?

Answer 21

Jaw thrust

Question 22

How should patient presenting with CSF rhinorrhoea be managed?

Answer 22

Diagnosis with CT in axial and coronal plane

Question 23

What is used to test for CSF in secretions?

Answer 23

Glucose oxidase
-> transferrin test

Question 24

When is CT head indicated within 8 hours?

Answer 24

*age > 65 years, coagulopathy
*dangerous mechanism of injury
* more than 30 minutes of retrograde amnesia of events immediately before the head injury

Question 25

What drug is an indication for CT head within 8 hours?

Answer 25

Anticoagulation, even without the need for loss of consciousness or risk factors

Question 26

What to do for patients who have regained consciousness after ventricular fibrillation?

Answer 26

15 litres of O2 via non-rebreathe mask

Question 27

What is torticollis?

Answer 27

Torticollis is a stiff neck that makes it hard or painful to turn your head

Question 28

What is the innervation of the sternocleidomastoid?

Answer 28

Motor accessory nerve

Question 29

What is the GCS at initial assessment for head CT within 1 hour?

Answer 29

Less than 13

Question 30

What is the GCS at after intial assessment for head CT within 1 hour?f

Answer 30

GCS less than 15 at 2 hours after injury

Question 31

How many episodes of vomiting for head CT in one hour?

Answer 31

More than one episode of vomiting

Question 32

What are general features for CT within one hour?

Answer 32

Post-traumatic stress seizure Open skull fracture Basal skull fracture Depressed skull fracture Focal neurological deficit

Question 33

What is the value for GCS after 2 hours for CT within one hour to be indicated?

Answer 33

Less than 15

Question 34

What is the value for GCS at inital assessment for CT within one hour to be indicated?

Answer 34

Less than 13

Question 35

What is the GCS for CT head on initial assessment?

Answer 35

GCS under 13

Question 36

What to suspect with fluctuating GCS on a background of a head injury In elderly patient ?

Answer 36

Subdural haematoma, causing crescent shaped haemorrhage on CT head. Delayed presentation is because the system that a subdural haematoma occurs in is lower in pressure than the system that an extradural haematoma occurs in (