{"id":2200,"date":"2020-01-23T14:38:04","date_gmt":"2020-01-23T12:38:04","guid":{"rendered":"https:\/\/temporary.mindd.dev\/?p=2200"},"modified":"2024-05-17T10:22:19","modified_gmt":"2024-05-17T08:22:19","slug":"case-head-trauma","status":"publish","type":"post","link":"https:\/\/huisartsenpostendelimes.nl\/en\/nieuws\/case-head-trauma\/","title":{"rendered":"Head trauma case"},"content":{"rendered":"\n<p><em>By Lucia van Vliet, general practitioner committee of inquiry into incidents and calamities<\/em><\/p>\n\n\n\n<p>Not long ago, the\nCommission of Inquiry into Incidents and Emergencies Faced with a\nCase concerning head trauma in an elderly lady. This lady passed away\nbecause the possibility of a subdural hematoma was not recognized in time. There\nthere seems to be a lack of clarity about the interpretation of the standard\nhead trauma of the NHG. When should someone with a head trauma be sent in?\nbecome? Which symptoms are sufficient on their own or which combination of\nfactors leads to submissions? <\/p>\n\n\n\n<p>The\nNHG standard makes a classification into: <\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>Head trauma with a <strong>greatly increased<\/strong>\nrisk of intra-cranial injury: This is the case with reduced consciousness,\na seizure, suspected skull base fracture or high energy trauma (IT).\nThese are referred <strong>as a matter of urgency<\/strong> . <\/li><li>Head trauma with an <strong>increased<\/strong>\nRisk of intracranial injury, at age&gt;16 years:<\/li><li>persistent vomiting, <strong>or<\/strong> <\/li><li>coagulation abnormalities <strong>or<\/strong> <\/li><li>severe antero- or retrograde anmesia <\/li><li>These symptoms are separate\nenough to <strong>send in or at least consult<\/strong> with the neurologist.<\/li><li>a combination of 3 symptoms or\nmore, (serious accident mechanism, but no IT, age&gt; 60 years, once\nvomiting, severe, unrecognizable headache, any\nloss of consciousness, clinically relevant external injury, alcohol and\/or\ndrug intoxication). <\/li><li>For this combination: <strong>send in or\nconsult<\/strong> with neurologist. <\/li><\/ol>\n\n\n\n<p>Concerning\nThe patient did not have a greatly increased risk, but she did have an increased risk,\nnamely: &gt;60 years old, vomited several times, unrecognizable headache and\nclopidogrel use. Because of this combination of symptoms, she had sent in\nshould be addressed. See also: <a href=\"https:\/\/www.nhg.org\/standaarden\/volledig\/nhg-standaard-hoofdtrauma\">https:\/\/www.nhg.org\/standaarden\/volledig\/nhg-standaard-hoofdtrauma<\/a><\/p>\n\n\n\n<p>Additions\non NHG standard:<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>In the NHG standard, TARs are\n(platelet aggregation inhibitors) not counted as anticoagulation; i.e. they\nwould not increase the risk of intracranial injury. There are more and more\nindications that the bleeding risk does appear to be increased by\nThis group of drugs (clopidogrel, acetyl salicylic acid). Adv: consider this group\nas an anticoagulant.<\/li><li>The guideline of the RAV and NVN are\nboth more proactive than those of the NHG. They assume higher percentages as\na priori risk of intracranial injury. As a result, when the patient\nAfter a head trauma&nbsp; 112 calls the chance\nHe will be transported to the hospital. It is also more likely to\nthat he gets a CT scan. The NVN calls vomiting a major criterion (regardless of\nhow often), together with some minor criteria, this leads to a CT more quickly. <\/li><\/ol>\n\n\n\n<p>Takeaways: <\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Think\nmore in risk (of intracranial injury) than in neurological abnormalities; that\nare often not there (yet).<\/li><li>Take\nthe family&#8217;s concerns are very serious.<\/li><li>Bee\nDoubt, combination of symptoms: consult with neurologist, even at night.<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>By Lucia van Vliet, general practitioner committee of inquiry into incidents and calamities Not long ago, the committee of inquiry into incidents and calamities was confronted with a case concerning head trauma in an elderly lady. This lady died because the possibility of a subdural hematoma was not recognized in time. There seems to be a lack of clarity about the interpretation of the standard head trauma of the NHG. When should someone with head trauma be sent in? Which symptoms are sufficient on their own or which combination of factors leads to submission? The NHG standard makes a classification into: Head trauma with a greatly increased risk of intra-cranial injury: Of these, [&#8230;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_trash_the_other_posts":false,"editor_notices":[],"footnotes":""},"categories":[47],"class_list":["post-2200","post","type-post","status-publish","format-standard","hentry","category-intern-nieuws"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Head trauma case - Huisartsenposten De Limes - English<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/huisartsenpostendelimes.nl\/en\/nieuws\/case-head-trauma\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Head trauma case - Huisartsenposten De Limes - English\" \/>\n<meta property=\"og:description\" content=\"By Lucia van Vliet, general practitioner committee of inquiry into incidents and calamities Not long ago, the committee of inquiry into incidents and calamities was confronted with a case concerning head trauma in an elderly lady. This lady died because the possibility of a subdural hematoma was not recognized in time. There seems to be a lack of clarity about the interpretation of the standard head trauma of the NHG. When should someone with head trauma be sent in? Which symptoms are sufficient on their own or which combination of factors leads to submission? 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This lady died because the possibility of a subdural hematoma was not recognized in time. There seems to be a lack of clarity about the interpretation of the standard head trauma of the NHG. When should someone with head trauma be sent in? Which symptoms are sufficient on their own or which combination of factors leads to submission? 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