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head CT

Krin135 at aol.com Krin135 at aol.com
Sun Oct 9 18:45:00 BST 2005

In a message dated 09-Oct-05 12:32:05 Central Daylight Time,  
scho26 at sbcglobal.net writes:

Had a  elderly lady PMH asthma, involved in a MVA  rollover,dx.  fracture  
pelvis..after twenty four hours she was found unresponsive she was intubated  
and sent to CT with a diagnosis of large SDH with midline shift. Unfortunately  
no CT of head was done in the ER.  Should this be protocol and is it  protocol 
in other level one hospitals, when the MVA is a  rollover???

was there any initial indication of loss of consciousness? were there any  
initial indications of head trauma? was she wearing her seatbelt at the time of  
the incident? how was her cervical spine cleared?
Admittedly, a history of pelvic fracture is a good indication of  significant 
force being applied to this 'little old lady' and is a classic  'distracting 
injury' under the Maine Protocols, but if there was no head trauma  and no 
history of loss of consciousness, then an ED head CT would have been  fairly low 
on the list of things that I would have been expecting to get prior  to 
shipping this woman off to the Trauma Center.
Remember that subdural hematomas are usually the result of venous bleeding,  
and can take quite a while to manifest symptoms. I suspect that an early CT  
would have been of no other use than to document 'yeah, she's getting worse!",  
which physical exam did admirably.

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