Head trauma workup


Sculpture Human HeadPatient’s chief complaint: “I was slapped on the back of my head with a file folder by a co-worker. I have a headache and I want a CT scan to make sure there’s nothing wrong on the inside.

In other words, “I really want to get my co-worker in trouble.”

Fortunately, it wasn’t one of those goth file folders with the spikes sticking out.

Danged if I didn’t have to consider a CT of the chest after putting my stethoscope on her chest to listen to her heart … and an MRI of her back after she laid on the table for the exam.


And she’ll probably end up getting the Press Ganey survey that blasts me for performing an inadequate workup on her.


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  1. Well if there’s no physical injury, there’s always the PTSD! Gotta be worth a few bucks, no?

    (and demanding an MRI to make sure I didn’t jog anything loose in there whilst doing so)

  2. Sharing the cost of unwarranted emergent CT that won’t be covered by insurance is usually a deterrent. Medical consequences of radiation exposure and accumulation another. Then I cheerfully offer the unwarranted test laying the burden of those considerations at the feet of the patient. Not many takers in my experience.

  3. Tis is the time to be serious and ask the patient to be likewise. I would acquaint him/her with the 400X CT ionizing radiation argument in addition to the risk of “virtual 0 of you with your normal INR having a brain bleed with this amount of trauma and a negative neuro exam”. Don’t feel pressured to do expensive , potentially dangerous exams when not indicated. You will have the support of every ER doc and Neurologist consulted. Present CYA costs are not sustainable and we are the front line folks to reverse it.

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