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The team leader should assign the roles and be in charge of the direction and decision making upon patient arrival and throughout the assessment. Other roles may include documentation, airway management, IV access, attaching monitoring devices, and medication administration. There must be one individual assigned as a team leader, usually the physician. Once the team is present, and ideally before the patient arrives, roles should be assigned. The trauma team may vary based on the hospital location and staffing but should, at a minimum, include a physician and nurse. After receiving this information, the healthcare team members should begin thinking of possible injuries that may be a threat to the patient's life. Emergency medical services (EMS) should provide information including mechanism of injury, patient vital signs, obvious injury, current interventions, and patient's age and sex if available. This includes gathering the care team, equipment, and initial information. Admission for observation is usually necessary, with further management determined based on the fracture.The first step in trauma assessment begins prior to the patient's arrival. Patients should be treated with tetanus toxoid and broad-spectrum antibiotics if they have an open wound or if the presentation has been delayed.īasilar skull fractures are secondary to trauma, and thus management requires a thorough trauma evaluation. Other indications for surgery include underlying hematoma, gross infection/contamination, and dural tear with pneumocephalus. The current consensus is that if the depressed segment is more than 5 mm below the inner table of adjacent bone, that the patient should undergo surgery to elevate that bone segment. Surgery is usually required when patients have depressed skull fractures. Children with linear fractures need to be admitted overnight irrespective of the absence/presence of neurological deficits. However, the patient must be available for follow-up if he or she becomes symptomatic. Patients with linear fractures who have no neurological deficits and have a GCS of 14 or higher can be discharged home safely after a period of observation in the emergency room. In general, the treatment following skull fracture depends on the type of injury.
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However, more research is necessary regarding the association between hepatic encephalopathy and mastoid ecchymosis. This case means that Battle sign may not be as specific for head trauma as initially thought. Īnother issue surrounding Battle sign is that there was a recent case report that showed mastoid ecchymosis associated with hepatic encephalopathy in the absence of trauma. īattle sign may be confused with a spreading hematoma from a fracture of the mandibular condyle, which is a less serious injury. Hewett, an English surgeon, had actually written about the association before Dr. Battle is credited with the sign and has his name on the sign, he was not the first to note the sign. Many believe that the sign gets its name from fighting or battling as a mechanism for obtaining the injury instead of the credit going to Dr. The naming of the Battle sign has caused much confusion over the years. One of the most important issues associated with Battle sign is that it takes 1 to -2 days for the sign to appear and is thus not helpful in the initial management of head trauma.