Indexing Title: JMDEGUZMAN’s Medical Anecdotal Report [04-1]

 MAR Title: Is vomiting an indication for cranial CT scan in Patients with Head Injury?

 Date of Medical Observation: April 26, 2004

 Narration:

            A 6 year-old male was brought in at the emergency room with a complaint of 3 episodes of vomiting after falling in a 5-steps stair. Patient had stable vital signs, irritable; 2x3cm hematoma noted at the occipital area, other Physical findings were normal. Glasgow coma scale of 15, no cranial deficits, nor pathologic reflexes on neurological evaluation. Skull x-ray showed intact bone structures.

            At the E.R., patient had one episode of vomiting. Venoclysis started. Cranial CT Scan was requested but not done, hence active observation was instituted. Patient was stable, coherent, alert, GCS 15 with no episode of vomiting one hour after arrival throughout the 12 hours observation. He was then discharged with proper advice.

            Final Diagnosis:  Hematoma, occipital area, Right

                                            Cerebral concussion

Insights (Discovery, Stimulus, Reinforcements)

            With the advent of CT Scan, closed head injuries were more defined. However, the indication is not well established, as an effect it became routine for attending physicians to request CT scan in Patients with head injury.