Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Fall With Gradual Drowsiness


Consult Page

3 year old girl status post fall with head strike, worsening GCS, CT with large brain bleed

Initial Imaging

Figure 1.1, Head CT without contrast axial (A) and coronal (B) views demonstrate a large 8.5 cm right parietal epidural hematoma with 1 cm midline shift. Note the ominous “swirl sign” or areas of hypodensity in the hyperdense clot, which is concerning for active extravasation.

Walking Thoughts

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    What is the patient’s current GCS score and neurological exam?

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    Does the patient have any other injuries?

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    Is the patient hemodynamically stable?

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    What is her past medical history? Does she have any bleeding disorders or take any anticoagulants or antiplatelet agents that need to be reversed?

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    Is there any concern for non-accidental trauma?

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    What labs have already been ordered or drawn?

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    What interventions including hyperosmotic therapies have already been administered?

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    When did she last have anything to eat or drink?

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    Are the parents/legal guardians available?

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