head CT

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No LOC at time of admission, she was sent to the floor and she communicated with staff thru the evening and early morning.  She was found unresponsive about an hour after her last check..No LOC reported in the EMT report or by pt or husband

DocRickFry at aol.com wrote:
In a message dated 10/9/2005 1:32:14 P.M. Eastern 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???




It is now pretty clear that mechanism should not dictate ANY specific 
evaluation--well established to be very unreliable, you should deal with the 
patient as they present to you. And you do not give the crucial bit of info needed 
to know if head CT should have been done on admission, tho I cannot imagine 
how it could not have been indicated with what you describe--was there any 
history of loss of consciousness or GCS<14 on arrival? This is the indication 
for head CT, nothing about mechanism.
ERF
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