Trauma

A. Indications for head CT

Focal deficit, anticoagulation, significant LOC, drug intoxication. Usually do not need (but highly recommended) to get a CT in pts with very brief LOC and no focal neurological signs.

B. Exam

Note exact time of exam and amount and time of last sedation.

1. General: Vital signs and pattern of respiration. Palpate head for skull fractures, facial fractures. Look for lacerations, raccoon eyes, battle sign (bruise behind ear). Fundi (papilledema, hemorrhage, retinal detachment). Blood in nose/ears; CSF leak (q.v., p. 20). Listen for bruits over eyes, carotids. Look for evidence of spine trauma.
2. Neuro:
- a. Quick: Assess alertness; coma exam (see p. 30), cerebellar exam if cooperative.
3. R/o spine injury:
- a. Rectal: Including anal wink and bulbocavernosus.
- b. Sensory: Pinprick all four limbs and trunk; touch major dermatomes C4, C6-8, T4, T6, T10, L2, L4-S2. Vibration and proprioception for posterior columns.
- c. Motor: In more detail than just noting “moving all extremities.”