Monday, September 12, 2011

Head Injuries

It has been a crazy two weeks since my boss is on vacation and I'm working more than my usual number of shifts.  Today I come home for a lunch break and was about to sit down for some nourishment when I hear a loud BANG.  I look over and my preschooler and her chair are tipped over on the ground.  She probably kicked the table with her legs despite the many times we've warned her not to... and this time her chair tipped.  I rushed over to assess the situation.

No blood.  Not much swelling.  However, I did have a loudly crying child who was terribly shaken up.  I coax her to calm down as I move her to the refrigerator so I can grab some ice.  I also couldn't help but started lecturing her on how this is why she should obey when we tell her not to do things... how mommies and daddies are always looking out for her best interest... and how she should never disobey anything we say ever again!

My dad was helping me babysit today and he is a pretty anxious person on a good day.  So the loud commotion drew him to the scene in a panic.  The string of nervous comments that followed only heightened the situation and caused my child to cry louder and start coughing.  Once the coughing started, I knew what was going to come... all her lunch.  She threw up and threw up... got it all over the floor, herself, and my skirt.  When we thought she was done, she threw up some more.  During these moments, I never know whether to move her to the bathroom or just stay put.  We stayed put.  I figured a puddle of throw up was easier to clean than a long trail.  Finally, things did settle down.  S got a bath and I changed into scrubs.  I still needed to get back to work but thankfully (though unusual for Monday) the schedule was lighter and I was able to stay home to monitor S a little longer.

So when do you take a child to the ER after a head injury?  And when do you need a CT scan after a head injury?

Well, when in doubt, never hesitate to call your physician and ask.  But here are some general guidelines...

Get your child evaluated after any head injury but you can call to determine whether that means bringing him or her into the primary care office or going straight to the ER.  Physicians are not as quick to get a head CT on a child anymore due to the high exposure of radiation.  In a developing body, they are more prone to long term risks such as cancer.  So there was a study of 40,000 children treated for head trauma in 25 emergency room centers between 2004 and 2006.  They found that 4 to 6 hours of observation reduced the amount of CT scans ordered with comparable outcomes as those who ordered ct scans right away.

So some signs that would have caused me to take my preschooler to the ER today for a head ct include:
  • if her vomiting recurred or did not resolve
  • if she became confused
  • if she had slurred speech or started to say things that did not make sense
  • if she had any visual complaints
  • if she had any difficulty with balance or her coordination
  • if she continued to fuss and cry and be irritable