![]() ![]() There is no clear evidence for or against the use of Ondansetron. These patients should be able to tolerate oral fluids in ED and be steady on their feet before discharge. If these patients do not fulfil the criteria for a CT head scan then they should be observed in ED for a minimum of 4 hours from the time of injury before they can be discharged (see Discharge from ED section below). ![]() Senior advice should always be sought regarding the need for a CT head scan. These children require 30 minutely neurological observations (GCS, pupils and limb power, HR, RR, BP) documented on a PEWS chart whilst in ED. These patients will have some of the significant risk factors described in Category 2 or Category 3but will not have a reduced GCS and will usually be managed in Majors.Īlways consider the need for appropriate analgesia. Consider IV 3% NaCl 3ml/kg as a bolus or IV Mannitol over 20minutesĪrrange an immediate CT head scan to be performed within 1 hour.Nurse 30 0 head up after correction of any shock.In conjunction with ED Consultant /PICU/ Neurosurgery consider measures to decrease intracranial pressure: Prevent secondary brain injury by maintaining adequate ventilation and oxygenation.Īlways consider the need for appropriate analgesia. Perform a primary survey and ensure the child’s airway, cervical spine, breathing and circulation are secure. These will be patients with significant risk factors described in Category 1 or Category 2 and may have a reduced GCS and will usually be managed in resus.Ĭonsider the need for a Trauma Call if not already triggered. A further episode of abnormal drowsinessĬhildren who have sustained a head injury but have none of the risk factors above do not require imaging.If during observation any of the risk factors below are identified perform a CT head scan within 1 hour. Amnesia (antegrade or retrograde) lasting more than 5 minutes.Ĭhildren who have sustained a head injury and have ONLY 1 of the risk factors in Category 2 (and none of those in Category 1) should be observed for a minimum of 4 hours after the head injury.Three or more discrete episodes of vomiting.Loss of consciousness lasting more than 5 minutes (witnessed).Suspicion of non-accidental injury – irrespective of scan result safeguarding procedures must be followed: Child Protection pathways where concern for neglect or abuse - RHC EDįor children who have sustained a head injury and have MORE THAN ONE of the following risk factors (and none of those in Category 1), perform a CT head scan within 1 hour of the risk factor being identified:.Post-traumatic seizure, but no history of epilepsy.For children Suspected open or depressed skull fracture or tense fontanelle.At 2 hours after the injury, GCS less than 15.On initial ED assessment GCS less than 14, or children Motor function – examine limbs for lateralising weakness and presence of reflexesįor children who have sustained a head injury and have ANY of the following risk factors, perform a CT head scan within 1 hour:.Look in the mouth for dental trauma, soft tissue injuries Look in the ears as blood behind the tympanic membrane (haemotympanum) is another sign of basal skull fracture any signs of basal skull fracture- bruising around the eyes (panda eyes) or behind the ears (Battle’s sign), CSF leak from the nose (rhinorrhoea) or from the ears (otorrhoea).Measure the diameter of any haematoma in <1yrs. for any scalp bruising, laceration, swelling or tenderness.The AVPU scale is used for the rapid assessment of neurological status during the primary survey.Īny patient with a head injury requires a formal GCS documented with pupils examined. As part of the primary survey perform an AVPU score and assess the pupils. golf club)įor any head injury patient in resus, brought by ambulance or Triage category 1 or 2, perform an immediate primary survey and ensure that the child’s airway, cervical spine, breathing and circulation are secure. High speed injury from a projectile or other object (e.g.Accident involving motorised recreational vehicle (e.g.High speed road traffic accident as a pedestrian or vehicle occupant.*Examples of Dangerous Mechanism of Injury include: Clinical course prior to consultation – improving/stable/deterioration.Assessment is not possible in preverbal children and unlikely to be possible before the age of 5 years ![]()
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