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Link of the Week- EMS Garage Podcast
Tip/Trick of the Week- Closed Head Injuries
The two common types of brain bleeds following a traumatic injury that includes a blow to the head are epidural and subdural hematomas. For paramedics and emergency medical technicians encountering these injuries in the field, diagnosis can be difficult. Often, the patients with these head injuries present with no significant side effects initially and will want to refuse treatment.
Because of the nature of these hemorrhages, the patients can deteriorate over time and become incapacitated and die from a lack of treatment. EMS providers in the field must use careful history taking and assessment to raise their index of suspicion and work with online medical direction to convince these individuals that they need to be checked out in the ER or trauma center.
The only definitive diagnostic tools are the use of medical imaging of the skull to look for signs of internal bleeding. Until this is done, there is no way of determining if there is a bleed present or not. Some patient populations have a higher risk for bleeding anyway and need even more careful assessment.
These higher risk patients include:
- Elderly patients because of physiologic changes that cause vessels to become more brittle.
- People on any form of anticoagulant therapy including aspirin, warfarin (coumadin), plavix, and others.
- People with prior history of brain injury and stroke
- Very young patients (under 5) due to inability to gauge communication and neuro status effectively.
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