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Head Trauma, Penetrating, Emergency Medicine

Gary M. Vilke Reviewed 06/2017
 


Basics

Description

Penetrating injury to intracranial contents: 
  • High-velocity penetration: Usually bullets, which cause trauma directly to brain tissue and also have a “shock wave” injury to local surr...

Diagnosis

Signs and Symptoms

  • Alteration in level of consciousness and neurologic exam varies based on object and location.

  • Evidence of increasing intracranial pressure:

    • Decreasing level of consciousness

    • F...

Treatment

Pre-Hospital

  • Stabilize but do not remove foreign object (e.g., knife).

  • Determine the weapon type or caliber of weapon at scene.

  • Protect and manage the airway to avoid hypoxemia.

  • Avoid hyperventi...

Follow-Up

Disposition

Admission Criteria

Admit all patients to ICU or transport directly to surgery. 

Discharge Criteria

Do not discharge. 

Followup Recommendations

All patients with penetrating skull injur...

Pearls and Pitfalls

  • Failure to query about anticoagulant use and image appropriately

  • Failure to aggressively reverse hypocoagulable states

Additional Reading

  • Badjatia  N, Carney  N, Crocco  TJ, et al. Guidelines for prehospital management of traumatic brain injury 2nd edition. Prehosp Emerg Care.  2008;12(suppl 1):S1–S52.

  • Brain Traum...

Codes

ICD9

  • 803.60 Other open skull fracture with cerebral laceration and contusion, unspecified state of consciousness

  • 803.90 Other open skull fracture with intracranial injury of other and unspecified ...

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