Stab head

[trauma newb]

How do you guys handle stab heads?  We had a guy come in with a knife to the head.  We basically just yanked it in the OR and sat around waiting with an open crani setup to see if he got worse.  After a half hour or so we took him to CT and then put him in the unit.

[Focus]

We haf an intraop ct. We typically pull it out, scan, then intraop angio, or if vascular injury highest concern we would do it in the angio suite and use the biplane to get a low quality cth after doing an angio.

[Percheron]

(02-01-2017, 09:17 PM)trauma newb Wrote: How do you guys handle stab heads?  We had a guy come in with a knife to the head.  We basically just yanked it in the OR and sat around waiting with an open crani setup to see if he got worse.  After a half hour or so we took him to CT and then put him in the unit.

stab head huh? that's got a nice ring to it... 

I had a guy with a 4 inch nail in the head: entered just in front of his tragus, neuro intact but sleepy. Got a CTA showing the nail stopped 1 mm short of his ICA bifurcation, with no associated hemorrhage. Pulled the thing out in the scanner right after CTA, then slid him back in to run a plain CT showing a small tract hemorrhage. He went home 2 days later.

My co resident had a guy that had stabbed himself in the temple with a big pair of scissors. Neuro intact as well. Got a non-con CT showing that it went right down the sylvian fissure, somehow without hemorrhage. They took him to OR, pulled it out and did a small incision extension of the penetrating wound to wash it out and stop local bleeding and observe for any deeper bleeding. There was none. Post op CT looked fine with small Subarachnoid blood. He did fine and went to a psych hospital a week later.

One of my attendings said that he got a boards question years ago with patient that had a through and through stab injury. He described pulling out the thing like in the above cases, the conclusion in his case was a CT with diffuse SAH and a patient with blown pupils. His lesson to me was that the boards answer is to carefully "resect" the thing with vessel control if it is crossing major vessels. ie big crani to expose the hole thing prior to pulling it out