Concluded Case

2yr male child fall from 10feet height four hours back.H/o vomting one episode present.No h/o seizures,loss of consciousness, ear nose throat bleeding.Child is active.GCS 15/15.What is the further Management???{chest&abdomen are normal}

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Concluded answer
As there is history of fall from height n black eye or cocoon eye sign of anterior cranial fossa injury. History of vomiting suggests head injury. Investigation of choice NCCT Head. If GCS is good manage conservatively n if GCS is less than 10 or midline shift more than 6cm or depressed fracture then go neurosurgeon opinion n operate the patient
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Pt has black eye lt side Scan is normal Neither bony injury or brain involvement Should be treated as contusion by cold icepacks and antiinflamatory suspension Prophylactic antibiotic may be added Keep followup
Thanx dr Ashok Leel
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Wait and watch. Vomiting may be due to concussion of the brain. If convulsions occur you can refer to am higher centre for CT SCAN orMRI and treat accordingly as per the reports
Thank you doctor
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This may be concussion injury so child vomited . CT scan is normal . Still need to observe for 48 hours for seizures or altered sensorium. Ophthal opinion is must .
Thank you doctor
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Agree with Dr Raghvendra Rao. Constant monitoring and regular evaluation required. Conservative treatment.
Thanks Dr Dinesh Gupta.
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Advisable.... 1. NCCT. HEAD 2. CONSTANT. MONITORING 3. CONSERVATIVE. TREATMENT
Lt frontal sdh.conservative management. Repeat ct agter 48 hrs
Thank you doctor
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Only conservative treatment for head injury like cold fomentation on localised haematoma left eye & frontal region, antibiotic cefaperazone-sulbactum/Liquid Droxyl,,liquid phenytoin,liquid Combiflam and dexona to reduce cerebral oedema will suffice.If vomiting persist give oral glycerol.The child will be ok in few days.We have to continue phenytoin for few months to avoid epilepsy development
As there is history of fall from height n black eye or cocoon eye sign of anterior cranial fossa injury. History of vomiting suggests head injury. Investigation of choice NCCT Head. If GCS is good manage conservatively n if GCS is less than 10 or midline shift more than 6cm or depressed fracture then go neurosurgeon opinion n operate the patient
Observe for 48 hrs..look for seizure opthal consultation for black eye & development of papiloedema..NPO, Prophylaxis iv antibiotics, antiepileptic drugs, PPI & Analgesics..If no seizure,& altered sensorium after 48 hrs of observation then stop IVF allowed orally ...Advice Neurosurgery/Gen Surgery consultation for SDH/EDH & Skull #..
If GCS15/15. It is O.K. but observation for 48 hours must. Haematomaand hemorrhage one must gofot CT to rule out fractureand bleeding in side. Opthalmic examwith fundus exam is also requested. Till that symptomatic management.
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