Trauma head algo v1

  • Child with minor blunt head trauma
    • RN Assessment
      • Checks
        • Targeted history and examination
        • Vital sings: BP, HR, RR, GCS, every 2 hours
        • Neuro check with pupil exam
        • Request immediate MD evaluation if clinical concern or significant status change
      • MD Assessment
        • Checks
          • History and examination
          • Assess age-based PECARN head trauma predictors
          • Consider immediate head CT for severe symptoms
        • Age < 2 years?
          • Yes
            • Altered mental status or palpable skull fx?
              • Yes
                • Head CT Recommended
              • No
                • Are the following predictors present?
                  • Check
                    • Non-frontal scalp hematoma
                    • Loss of consciousness > 5 sec
                    • Severe injury mechanism
                    • Acting abnormally as per parent
                  • No Predictors
                    • Head CT Recommended
                  • 1-2 Predictors
                    • ED observation
                      • Monitor 4-6 hours from time of injury
                      • Obtain head CT if symptoms worsen or don’t improve during observation
                  • > 3 Predictors
                    • Head CT Recommended
          • No
            • Altered mental status or clinical signs of basilar skull fx?
              • Yes
                • Head CT Recommended
              • No
                • Are the following predictors present?
                  • Check
                    • Any loss of consciousness
                    • History of vomiting
                    • Severe injury mechanism
                    • Severe headache
                  • No Predictors
                    • Head CT Recommended
                  • 1-2 Predictors
                  • > 3 Predictors
                    • Head CT Recommended

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