Transcript Medications

Going Home After a
Head Injury
Jacqueline McPherson
Paediatric Neurology Nurse Specialist
Ward 7
Neuroscience Department
RHSC
Head Injuries
April 2011 – March 2012
• Attended A&E - 1419
• Admitted from A&E – 113
Classified into mild = GCS 13-15
moderate = GCS 9-12
severe = GCS 8 or less
(SIGN)
Mild-Moderate Head Injury
• Support, information, advice and
reassurance for child & family
• School/Nursery point of contact
• Ward review
• Out-patient (OP) clinic appointment;
paediatric neurosurgery and/or paediatric
neurorehabilitation
Moderate – Severe Head Injury
• A period of neuro assessment and
rehabilitation
• Integrated Care Pathway
• Link with Education – point of contact
• ‘Wean’ off ward; day pass, overnight pass,
weekend pass
• Regular ward reviews and OP appointments
FAQ
• Mood & Temperament
• Memory
• Fatigue – especially returning to
school
• Sports
SIGN Guidelines
• Mild - Some evidence to show that some
children will have moderate disability and
this group would benefit from
telephone/postal follow up
• Moderate/Severe – follow up is of benefit in
terms of reducing behavioural changes,
reducing anxiety and reducing reporting of
symptoms
Case Studies
Case Study 1
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11 year old girl
Fell from monkey bars
No loss of consciousness (LOC)
Travelling to local emergency department (ED)
became sleepy and incoherent
• CT showed a fracture extending through R
mastoid and into the temporal bone, a small
extradural (3mm) and a small pneumocephalus
• Transferred to Royal Hospital for Sick Children,
(RHSC) Edinburgh and admitted into ward 7
Case Study 1 Cont:
• Post traumatic amnesia (PTA ≤24hrs)
• Continued with significant headaches and a
further vomit
• Repeat scan showed no change
• In-patient for 4 days
• Remained neurological stable
• Discharge home with 6 week Neurosurgical
follow up.
Case Study 1 Cont:
• Paediatric Neurology Nurse Specialist
(PNNS) in frequent contact with Mum for
support and information
• PNNS in contact with school about phased
return and any difficulties which may be
present
Case Study 2
• 3 year old boy
• Fell 2 stories onto concrete
• Sustained a severe head injury/traumatic
brain injury
• Intubated in Emergency Department
Case Study 2 cont:
• CT scan showed right subdural collections,
frontal lobe contusions and dramatic fracture
from left parietal to right spheroid bone with
injury to right orbital roof and adjacent
muscles and proptosis (forward
displacement of the eye)
• Transferred and admitted into intensive care
unit (ITU)
Case Study 2 cont:
• On going problems with raised intracranial
pressure
• Underwent bifrontal decompressive
craniectomy (subsequent re-insertion of
autologous frontal bone flap)
• Extubated and transferred to neuroscience
unit (ward 7) for rehabilitation – 2/52
• Multidisciplinary team discharge planning
meeting 5/52
• Discharged home – 6 weeks after initial injury
Case Study 2 cont:
• Attending ward reviews and outpatient
appointments
• Health Visitor for information and advice
• Nursery School for information, advice and
reassurance
• Transition meetings; nursery to primary
• Neuropsychology assessment
• Long term follow up
Service Development
• Promote Role
• Enhance referral system e.g.
surgical ward admissions
• Information packs