See also “ Prevention of complications in head injuries”.Consider seizure prophylaxis after TBI.Consider CNS infection prophylaxis for open head injury.Perform acute wound management, including scalp laceration management as needed.Neurological impairment, repeated vomiting, and seizures indicate potentially severe cerebral trauma or intracranial hemorrhage. Perform further diagnostics as needed (e.g., ocular examination, otoscopy, CT cervical spine).Īssume patients with high-impact head trauma have a cervical spine injury until it has been ruled out.Evaluate for associated injuries, e.g., facial fractures, cervical spine injury, traumatic eye injuries, carotid or vertebral artery dissection.Assess for cranial vault deformities and evidence of basilar skull fractures.Secondary survey (once the patient is stabilized).If signs of TBI are present, begin TBI management.Perform a rapid neurological examination.Hemostatic control of obvious sources of bleeding, e.g., scalp laceration management.Airway management and mechanical ventilation as needed, e.g., due to low GCS.C-spine immobilization and neuroprotective measures.See also “ Facial fractures,” and “ Orbital floor fractures” in “ Traumatic eye injuries.” Overviewįollow the ATLS algorithm for any patient with a potentially significant head injury, and maintain a low threshold for early specialist consultation (e.g., neurosurgery). Open head injuries can occur when skull fractures are associated with rupture of the dura mater, which can increase the risk of CNS infection. Expectant management may be sufficient for simple fractures but neurosurgery may be necessary for unstable fractures and fractures with associated complications. Complications of skull fractures include CSF leaks (which increase the risk for meningitis), cranial nerve disorders (due to compression or transection), and epidural hematomas. Initial management of skull fractures focuses on identifying and addressing life-threatening injuries. Clinical features vary depending on bone involvement but may include lacerations, contusions, and hematoma of the scalp palpable deformities mobile bone fragments liquorrhea Battle sign raccoon eyes and signs of traumatic brain injury. Basilar skull fractures involve one or more of the skull base bones and are classified as anterior, middle, or posterior cranial fossa fractures. ![]() Cranial vault fractures involve one or more of the cranial vault bones, may be either open fractures or closed fractures, and are classified as linear skull fractures or depressed skull fractures. They are classified by anatomical location as either cranial vault fractures or basilar skull fractures. Skull fractures most typically occur as a result of blunt force trauma from contact sports, motor vehicle collisions, or falls.
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