‘Blood Draining Inside My Head’

Have you ever picked up a chart, glanced at the chief complaint, and immediately thought, "Really! How do they know that?"   If you practice long enough, you will hear chief complaints such as "feels like spiders are crawling inside me," "feels like my muscles are falling off my bones," or something equally improbable. Yes, some might be delusional, but others just may be trying to give you the best clues they can.   "I Feel Blood Draining Inside My Head" A 19-year-old man with no active medical conditions was brought to the emergency department five days after an assault during which he was knocked unconscious by a blow to the right side of his head. He has had a headache, nausea, and vomiting since that time, although he had not vomited since the day before.   The patient's father was concerned that his son was having difficulty walking and was just not himself. The teen attributed his ambulatory difficulties to knee abrasions sustained when he fell. He did complain of headache and felt "blood streaming" down the right side of his head. The patient denied confusion, diplopia, vision changes, focal weakness, or paresthesias. The neuro exams before and after his CT were reported as normal, including his mental status.   Here is the CT. Epidural hematomas occur in different locations:• Temporal/temporoparietal: 70%• Frontal: 10%• Parieto-occipital:10%• Infratentorial/posterior fossa: 10% The prognosis and prese...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs