Test Your Knowledge of Closed Head Injuries (Postscript 2 of 4)

EBUC Postscripts
Management of Closed Head Injuries in Urgent Care | May 2022

Which of the following patients can safely avoid a head CT and/or ED transfer?

A. A fussy but alert 18-month-old girl who is brought to the urgent care clinic by her parents after being struck by a thrown baseball. She has a parietal scalp hematoma, but a normal GCS score and no history of loss of consciousness (LOC).

B. A 72-year-old man who presents to the urgent care clinic with his wife after a slip and fall in his bathroom. He struck his forehead on the sink but had no LOC, according to his wife. He reports that he felt “dazed and foggy for a couple of minutes,” but is now asymptomatic. He takes no antiplatelet or anticoagulant agents, and has a normal neurologic exam.

C. A 38-year-old woman who presents to the urgent care clinic following a bicycle accident. She was helmeted and went over the handlebars after dodging a car and striking a curb. She landed on a concrete sidewalk and struck her head. She doesn’t think she was knocked out, but complains of a headache that is 7 of 10 on the pain scale, as well as right shoulder pain, right chest wall pain, and upper abdominal pain. 

D. A 17-year-old young man who is brought to the urgent care clinic by his father after being struck helmet-to-helmet by an opposing player in a football game. He had a very brief LOC and transient disorientation according to the team trainer’s report. The patient is healthy and not taking any medications. The injury occurred 2 hours before presentation and he has a GCS score of 15, no current symptoms, and a normal neurologic examination.

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Last Updated on January 26, 2023

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