頭部外傷三大決定

Skull X-ray Indication:

• Loss of Con's or amnesia at any time.
• Abnormal neurological symptoms or signs
• Suspected penetrating injury, swelling, or scalp bruising, , but not a simple laceration.
• Intoxication.
• 難以評估時，例如癲癇，mental subnormality，還有很小的小朋友。

頭部外傷後住院的 indication:

• Contusion or impaired Con's on examination
• Skull Fx
• Abnormal neurologic signs, headache, or vomiting.
• 難以評估時，例如癲癇，mental subnormality，還有很小的小朋友。
• 其他內科的狀況，如血友病。
• Bad social conditions or lack of responsible adult or relative

須會診 NS

• Skull Fx and:
  • confusion & impaired Con's,
  • focal neurological signs
  • fits
• Confusion or neurological signs lasting > 12 h
• Coma continuing after resuscitation
• Suspected open Fx of the vault or base of the skull
• Depressed skull Fx
• Deterioration in the level of Con's or neurological signs

所以：

• 懷疑撞擊力量大，不只是撕裂傷→照頭部 X 光
• 有Skull Fx → 先別急著縫好傷口。找 NS 來處理。
• 曾經昏倒或失去記憶，或有不正常的 neurological sign ，或是難以評估者→照頭部X光，準備住院。