trauma-list Digest, Vol 65, Issue 14

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Yes I agree it's a waste of time. Especially ICU admission. In most parts of 
the world they probably don't even get picked up. I certainly don't scan 
patients with GCS 15 because I don't see the point of irradiating their 
brains esp when young, just so I could tell them they have a bleed (should 
one get picked up) but we won't do anything about it anyway. They can easily 
be observed on a ward with hourly obs over night. Should we be re scanning 
them?
I'm not sure- again more radiation in an asymptomatic patient. Are we 
treating the patient or the picture?
If they live close by and have good home support- i.e. someone who can keep 
an eye on them then the chances of ther being a late bleed are small and 
even if it happens it's rarely sudden. I had one patient who fell off a 
horse, LOC 15 min, amnesia etc but was absolutelly fine in the ED. We 
scanned him the following day because he was on warfarin, observed in AAU 
over night. Scan was normal and he was discharged home. Represented 6 weeks 
later with a large subdural which needed draining (no other trauma)- he was 
getting worsening headaches for 1 week prior to that and for a couple of 
days noticed having problems driving. He mada a full recovery.
trat the patient you wont go wrong.

Martin Sosnowski MB, ChB, FRCS Ed, FCEM
Consultant EM
Wanganui
NZ


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Sent: Friday, November 14, 2008 1:00 AM
Subject: trauma-list Digest, Vol 65, Issue 14


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> Today's Topics:
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>   1. RE: head injury (Sherry, Scott :LPH Trauma)
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