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Suggest Treatment For Black Bruised Eye And Nose Bleed After An Injury
Question: my 16 year old son has a fractured skull and has just had mri scan and has epidural hematoma 2.3cm x 1.5 cm and is in hospital tonight for observation. happened 48 hrs ago fell off 3foot high XXXXXXX wall onto concrete. was unconscious, went to a and e and had a wound glued together on head. has black closed eye and blood from nose.
Do you think he might need surgery? Do I need to get him to a specialist as so far he has only seen and casualty room doctors.
Brief Answer:
Emergent transfer to LEVEL 1 Trauma centre
Detailed Answer:
Thank you for asking!
I am sorry for your son accident. What he has been done with is a standard procedure. It is to stabilize the patient first by initial resuscitation which includes assessment and stabilization of airway patency, breathing, and circulation,a thorough trauma evaluation etc all followed by emergent transfer of the patient to the nearest level I trauma center supported with neurosurgical consultation.
There then it will be decided whether to treat this hematoma conservatively or should be intervened depending upon the circumstances like level of involvement, Conscious levels, Intracranial pressures and adequate cerebral perfusion pressure and euvolemia.
Meanwhile close monitoring for all vitals and pressures i mentioned above and elevation of the head of the bed at an angle of 30 degrees is advised. IV fluids to rehydrate and bleeding profile monitoring and observation is the key unless neurosurgical consultants see it.
Lets hope it gets managed by conservative therapy otherwise surgical interventions which will evacuate it definitely , will be needed. Craniotomy or laminectomy will be followed by evacuation of the hematoma, coagulation of bleeding sites, and inspection of the dura. The dura will then be tented to the bone and epidural drains will be employed for as long as 24 hours.
Get him to the level one neurosurgical trauma centre.
I hope it helps.Dont forget to close the discussion please.May the odds be ever in your son's favour.
S Khan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thankyou for your reply. My son has not yet even seen the neuro dept only orthopedics and I am arguing with his current hospital to have him transferred to a hospital with neuro doctors and the hospital he is at doesnt seem to have this speciality. They want me to wait til doctors do their rounds sometime today. Overnight his eye further swelled up, but other obs fine.
60 hours on i feel he needs to be seen by the correct specialty doctor, but cant seem to get a referral quick enough. ought i just take him to a and e at a hospital that does have appropriate care, ie check him out of his current hospital in the next few hrs if i dont get any joy?
Brief Answer:
Wait for the protocol
Detailed Answer:
Thank you for asking!
I appreciate your concern and i understand the trouble here. 60 hours is enough time for initial resuscitation. The referral should have been done way earlier. Its good that the kid is stable. Let the round be complete , wait for their protocol as it will help the admission in the required specialty.I believe they entertain only referred patient so skip the thoughts of taking the patient on your own. You have waited enough. Should wait a bit more. And hope for the best.Soon you will be referred.
Good Luck
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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