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A Z.of.Emergency.radiology.3HAXAP

A Z.of.Emergency.radiology.3HAXAP

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05/22/2012

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xi

ABCs – Airway,breathing,circulation (according toATLS protocol)
AC

– Acromio-clavicular

A&E

– Accident and emergency

AP

– Antero-posterior

ASB

– Anatomical snuff box
ATLS – Advanced trauma life support
AXR

– Abdominal X-ray
BiPAP – Bidirectional positive airway pressure
COPD – Chronic obstructive pulmonary disease
CSF

– Cerebrospinal fluid

CT

– Computed tomography

CXR

– Chest radiograph

DPL

– Diagnostic peritoneal lavage

ECG

– Electrocardiogram

ESR

– Erythrocyte sedimentation rate

ENT

– Ear,nose,throat

GA

– General anaesthesia

GCS

– Glasgow coma scale

ICH

– Intracranial haemorrhage

ICP

– Intracranial pressure

i.v.

– Intravenous

IVC

– Inferior vena cava

IVP

– Intravenous pyelogram

KUB

– Kidney,ureter,bladder
MRI – Magnetic resonance imaging
NAI – Non-accidental injury
NG

– Nasogastric
NOF – Neck of femur
NSAIDs – Non-steroidal anti-inflammatory drugs
OPG

– Orthopantomogram

PA

– Postero-anterior

PC

– Pelvicalyceal system
PEEP – Positive end expiratory pressure
PUO

– Pyrexia of unknown origin

RLQ

– Right lower quadrant

SAH

– Subarachnoid haemorrhage

SDH

– Subdural haematoma

SMV

– Submentovertex
SUFE – Slipped upper femoral epiphysis

List of abbreviations

xii

TC

– Transverse colon

TIA

– Transient ischaemic attack
TMJ – Temporomandibular joint
TB

– Tuberculosis
WCC – White cell count
US

– Ultrasound

List of abbreviations

xiii

Head injury 2 years

Loss of consciousness 1 minute
Focal neurology
Basal skull #
↓ Mental state
Bulging fontanelle
Vomit
– worsening
– 5 times
– 6 hours

Admit

CT

Y

Y

Y

N

Y

Y

N

N

N

Skull #

Skull X-ray

Meet discharge
criteria?

Discharge

Discharge criteria

1. Nitric oxide neurological symptoms
2. Nitric oxide significant extra cranial injuries/illness
3. Nitric oxide suspicion of neglect/abuse
4. Reliable parents/guardians
5. Appropriate discharge advise
6. No parental concerns re-behaviour
7. Have good access to hospital (transport/location)

NB: If unsure, ask senior advice.

Scalp swelling/haematoma
Poor history
Difficult to assess
Vomiting
Significant history
– Fall patient height
– High speed

(?NAI)

(?NAI)

Proposed algorithms

Algorithm for the management of head injury
in children
2 years

xiv

Head injury 16 years

See separate chart

N

N

Y

N

N

Y

Y

N

Y

N

N

Improving?

Meet discharge
criteria?

Discharge

Admit

NB: The National Institute of Clinical Excellence (www.NICE.org.uk) had recently
released guidelines relating to the management of adult head injury.

NB: Refer neurosurgery if:

GCS 8

CT ve

Fully recovered?

Y

N

GCS 12

Y

Y

Skull X-ray

Skull #

Observe up to 4 hours
senior review

CT scan

Focal neurology
Not improving
GCS ↓

Y

N

Loss of consciousness
Amnesia
Vomiting
Poor history
Abnormal behaviour
Violent mechanism
Full thickness lacn
Boggy haematoma
Seizure activity
Focal neurology

Y

2 years

GCS 15

Proposed algorithms

Algorithm for the management of head injury
in children
16 years

HEADANDFACE

SECTION

1

CEREBRAL CONTUSION 2

EXTRADURAL HAEMATOMA 4

FACIAL FRACTURES 6

SKULL FRACTURE 12

STROKE 16

SUBARACHNOID HAEMORRHAGE 18

SUBDURAL HAEMATOMA 20

Characteristics

Commonest form of traumatic intra-axial injury.

Contusions occur at the inferior and polar surfaces of the frontal and
temporal lobes.

Injury results secondary to contact with bony surfaces during deceler-
ation and is produced by damage to parenchymal blood vessels leading to
petechial haemorrhage and oedema.

Contusions develop in surface grey matter tapering into white matter.

Injuries may be coup or contra-coup.

Cerebral contusions are also produced secondary to depressed skull fractures
and are associated with other intracranial injuries.

Clinical features

Usually associated with a brief loss of consciousness. Confusion and
obtundation may be prolonged.

Focal neurological deficit can occur if contusions arise near the sensori-
motor cortex.

Most patients make an uneventful recovery but a proportion develop
raised intracranial pressure (ICP), post-traumatic seizures and persisting
focal deficits.

Beware of the elderly patients,alcoholics and patients taking anticoagulants
as they are at increased risk of haemorrhage.

Radiological features

Non-contrast computed tomography (CT) useful in the early post-
traumatic period.

Contusions are seen as multiple focal areas of low or mixed attenuation
intermixed with tiny areas of increased density representing petechial
haemorrhage.

True extent becomes apparent over time with progression of cell necro-
sis and oedema.

Magnetic resonance imaging (MRI) is the best modality for demonstra-
tion of oedema and contusion distribution.

Management

Secure airway whilst the cervical spine is protected.Supplemental oxygen.
Assess and stabilise breathing and circulation.

If Glasgow coma scale (GCS) 8 discuss with anaesthetist as a definitive
(secured) airway is required.

Early discussion with radiologist and neurosurgeon.

Titrateopioidanalgesia.Cleanseandclosescalpinjuries.Discusswithaneu-
rosurgeon regarding intravenous (i.v.) antibiotics,steroid and mannitol use.

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