second guessing myself -- help!

Published

I am actually a school nurse, hoping someone can answer a question for me. I had a kid in today who hit his head on a concrete floor. When he came in, he was in a lot of pain and said he was dizzy. There was very little edema where his head hit. Here's the wierd part -- pupils at first were PERLA, checked a few minutes later and the right one was sluggish. While waiting for dad to pick him up and take to the ER, checked again and they were normal. Is that possible? Did I imagine the sluggish response? Would it indicate fluctuating pressure? The other thing that struck me as odd was that he pointed to a different area of his head from where the bump occurred when I asked him where it hurt. He also denied any improvement in the dizziness. Any input would really be appreciated. Sorry for the long post!

Up Vote Up Vote ×
Specializes in Emergency Only.

Coup Contrecoup.

Coup means a blow or a strike. Contra means in opposition to what is expected, in contrast to. Contrecoup denotes an injury, as to the brain, occuring at a site opposite to the point of impact.

It is very Dangerous. Especially a hard impact, depending on which regions become affected.

If your worried that couldn't happen with the pupils? It would not suprise me if I saw that happen.

Up Vote Up Vote ×
Specializes in Trauma/ED.

In the ED they would have given education to the parents on s/s to watch for and discuss the option of a head CT...we have gone away from CT'ing every kids head but usually leave it an option for the parents to decide if they want the exposure or not. Don't beat yourself up for what looks like the appropriate actions you took, I have seen some strange things with pupils and CHI (closed head injury). You can see odd pupil responses with a lot of conditions, try looking at pupils with some migraine patients :)

Up Vote Up Vote ×
In the ED they would have given education to the parents on s/s to watch for and discuss the option of a head CT...we have gone away from CT'ing every kids head but usually leave it an option for the parents to decide if they want the exposure or not. Don't beat yourself up for what looks like the appropriate actions you took, I have seen some strange things with pupils and CHI (closed head injury). You can see odd pupil responses with a lot of conditions, try looking at pupils with some migraine patients :)

Who knows what they actually did; however, many of the newer protocols are getting away from CT scans. You are absolutely correct that people need to know about the cancer risk associated with CT exposure. This is especially true of kiddos.

Up Vote Up Vote ×

thanks for the reassurance. :)

Up Vote Up Vote ×
Specializes in Emergency Only.
however, many of the newer protocols are getting away from CT scans. You are absolutely correct that people need to know about the cancer risk associated with CT exposure. This is especially true of kiddos.

Really? Do you think that forty CT scans in just under Five years is wierd? I do!

Would you be able to let that continue on? I mean, if it is soo bad?.., as in that example I gave above:

(something that I would definitely have not liked to ever say I had been involved in---at, well, at any time...).

Just say NO! No more exams ma'am! Your done.

That is strange to me. Who goes to the ED repeatedly, again-and-again? 40?

Up Vote Up Vote ×

I am not sure I follow you?

Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
I am not sure I follow you?

Okay, good .... thought it was just my brain not functioning. ;)

Up Vote Up Vote ×
Specializes in Trauma/ED.
Really? Do you think that forty CT scans in just under Five years is wierd? I do!

Would you be able to let that continue on? I mean, if it is soo bad?.., as in that example I gave above:

(something that I would definitely have not liked to ever say I had been involved in---at, well, at any time...).

Just say NO! No more exams ma'am! Your done.

That is strange to me. Who goes to the ED repeatedly, again-and-again? 40?

This may be the strangest post of seen on here...can you fill us in to what the heck you are talking about...now I'm curious?

Up Vote Up Vote ×
Specializes in ER.

I subbed today as the HS nurse and had a young man who had been struck on the head yesterday during Lacrosse. He says it was a body impact to his head, not the ground or another head. He came in earlier in the day and said he had a headache from this injury, I gave him Tylenol, told him to come back if it didn't improve. He came back later with unchanged h/a pain, pupils PERRLA, but complaining of occasionally blurred vision and feeling as though he was unable to focus as usual. Being the ER nurse, I couldn't get it out of my head of a head injury, so I told him I was going to call his dad and inform him. After relaying my concern, he said "I'll just see him when I get home." I have taken care of a teenager in the ER who had a subdural after a collision with another player in basketball... I'm always thinking worst case scenario. I can't imagine why a parent would not take a kid in, after urging the dad to come get him. arggghhhh!

Up Vote Up Vote ×
Specializes in ER.
Really? Do you think that forty CT scans in just under Five years is wierd? I do!

Would you be able to let that continue on? I mean, if it is soo bad?.., as in that example I gave above:

(something that I would definitely have not liked to ever say I had been involved in---at, well, at any time...).

Just say NO! No more exams ma'am! Your done.

That is strange to me. Who goes to the ED repeatedly, again-and-again? 40?

I'm confused.....

Up Vote Up Vote ×
Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
I'm confused.....

Don't worry -- you're not alone! :)

Up Vote Up Vote ×
+ Join the Discussion