Head Trauma
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 11 September 2016
⏱️ 10 minutes
🧾️ Download transcript
Summary
CT scan without contrast is your test of choice.
Step 1: Consider Your Differential Diagnoses
* Five high-yield head trauma diagnoses* Skull fracture* External skull fracture* Basilar skull fracture* Epidural hematoma* Subdural hematoma* Traumatic subarachnoid hemorrhage (SAH)* Concussion
Step 2: Important Add-ons When Taking History
* Specific mechanism of injury* Loss of consciousness* Blood thinners/antiplatelet agents
Step 3: Important Add-ons To Your Physical Exam
* GCS Score (MDCalc)* Pupils* Basilar Skull Findings* Raccoon eyes* Battle sign* CSF rhinorrhea* Hemotympanum
Step 4: Calculate Canadian Head CT Rule
* Only apply to patients with…* Loss of consciousness* Amnesia to event* Witnessed disorientation* Exclude patients with* Blood thinners* Seizure(s)* Age <16* High risk criteria* GCS <15 2 hours post injury* Suspected open/depressed skull fracture* Signs of basilar skull fracture* 2 or more episodes of vomiting* Age >65* “Moderate” risk criteria* Retrograde amnesia >30 minutes* Dangerous mechanism* Fall >3 ft* Motor vs pedestrian* Ejected from MVA
Additional Reading
* Canadian CT Head Injury/Trauma Rule (MDCalc)* Evaluation and Management of Concussion in Sports (AAN)
Transcript
Click on a timestamp to play from that location
| 0:00.0 | Hello, med students. My name is Zach Olson and thank you for downloading this episode of the EM |
| 0:07.2 | Clerkship Podcast. This month I've been in the city of Memphis, eaten some barbecue and seeing a ton |
| 0:15.7 | of ridiculous trauma on my trauma rotation. And so sticking sticking with this theme, over the next several episodes, |
| 0:24.4 | we're going to be talking about different types of trauma, starting with today's case. |
| 0:35.1 | University Hospital of Delta 7 Med Flight, Andrew with a trauma alert. |
| 0:39.3 | We have a 19-year-old male patient with an unrestrained driver and head-on collision with ejection. |
| 0:45.3 | Patient intubated on Zine, currently BP 200 over 140, pulse of 110, showing good end tidal waveforms. |
| 0:53.3 | Pupils are unequal and fixed. |
| 0:55.0 | Glucose is 140. |
| 0:57.0 | Skin is pale and clammy. |
| 0:59.0 | It's showing sinus stack on the monitor. |
| 1:02.0 | The patient is bordered and collars at this time. |
| 1:05.0 | Flight time to your facility is approximately 10 minutes. |
| 1:12.0 | Lots going on here, but unrestrained driver, blown pupil, sounds like a bad head injury |
| 1:18.3 | probably. In ATLS, this is primary survey, letter D, disability, head injury. |
| 1:26.3 | The most important thing to remember from this episode is your imaging. |
| 1:33.0 | CT scan without contrast. |
| 1:36.3 | We'll get into when to order this in a bit, but the CT scan without contrast is the most important test for one big reason. |
| 1:46.1 | It highlights blood. |
| 1:49.9 | Blood turns up white on a CT head without contrast. |
| 1:54.3 | It's easy to see, and that is why it's your primary imaging of choice in head injury patients. |
| 2:00.6 | Now, our approach. First, think through |
... |
Please login to see the full transcript.
Disclaimer: The podcast and artwork embedded on this page are from Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD, and are the property of its owner and not affiliated with or endorsed by Tapesearch.
Generated transcripts are the property of Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.
Copyright © Tapesearch 2026.