Head trauma
Head trauma is injury to the head from any cause. An important distinction is between blunt and sharp trauma. Immediate assessment is by checking the level of conciousness and the Glasgow Coma Scale, as well as monitoring the GCS over time and observing the pupillary reflexes. Assessments of the neurological system are vital in cases of head trauma. Brain injury can be at the site of impact, but can also be at the opposite side of the skull due to a contrecoup effect. Moreover, pressure against the skull by the brain, caused by hematomas or hemorrhages at the site of impact, can further damage more brain tissue. Craniotomy surgeries are used in these cases to lessen the pressure. Specific problems after head injury include: Cranial bone fractures (e.g. skull fracture) Lacerations and/or hemorrhage from the skin Traumatic subarachnoid hemorrhage Traumatic subdural haematoma (may develop slowly) Traumatic epidural hematoma (or "extradural hematoma") Cerebral contusion An important predictor of prognosis is whether there has been loss of conciousness, vomiting or any neurological deficit (e.g. weakness in a limb). Combinations of these may warrant early CT scanning and neurosurgical intervention. In those with mild trauma, home discharge is often possible. Frequently, the advice is given to rouse the patient several times during the next 12-24 hours to assess for worsening symptoms.
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