Emergency Medicine Book

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Management of Mild Head InjuryAka: Mild Traumatic Brain Injury, MTBI

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  1. See Also
    1. Head Injury
    2. Management of Moderate Head Injury
    3. Management of Severe Head Injury
  2. Criteria
    1. Glasgow Coma Scale: 14-15
    2. Loss of consciousness may have occurred with injury
    3. Awake and oriented with normal Neurologic Examination
  3. History
    1. Time and mechanism of injury
    2. Level of Consciousness
      1. Immediately post injury
      2. Subsequent evaluations
    3. Amnesia (Retrograde and antegrade)
    4. Headache
    5. Seizures
  4. Exam
    1. Exclude concurrent systemic injury
    2. Limited Neurologic Exam
  5. Labs
    1. Blood Alcohol level
    2. Urine Tox Screen
  6. Radiology
    1. Head CT
      1. See Head Injury CT Indications in Adults
      2. See Head Injury CT Indications in Children
    2. C-Spine XRay as indicated
    3. Skull XRay Indications
      1. Penetrating Head Injury
      2. CT Head not available
  7. Criteria for Hospital Observation
    1. No CT scan available or abnormal CT Head
    2. All penetrating head injuries
    3. History of loss of consciousness
    4. Deteriorating Level of Consciousness
    5. Moderate to severe Headache
    6. Significant Alcohol or drug intoxication
    7. Skull Fracture
    8. Cerebrospinal Fluid leakage (Otorrhea or Rhinorrhea)
    9. Significant associated injuries
    10. No reliable companion at home or displaced home
    11. Amnesia
  8. Criteria for home observation
    1. At least six hours after injury
    2. Normal clinical exam
    3. Normal Head CT without acute injury
  9. Discharge instructions
    1. See Head Injury Precautions
  10. References
    1. Lawler (1996) J {a 5680} Rehabil 11:18
    2. Jagoda (2002) Ann Emerg Med 40:231

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