Occasionally a patient will have a penetrating head injury and not remember the event. If the penetrating object is not seen then it may be left in place, sometime for a prolonged period. Failure to detect and remove a retained foreign body can be fatal for the patient.


Types of retained object:

(1) bullet

(2) knife blade that has broken off

(3) shrapnel

(4) other penetrating object


Reasons why the person may not remember the head injury:

(1) intoxicated

(2) unconscious at the time

(3) post-traumatic amnesia

(4) severe mental impairment


Reasons for failing to detect the retained foreign body in the Emergency Department:

(1) failure to perform a complete physical exam of the head, include a careful palpation of the scalp

(2) failure to appreciate the significance of an apparently small wound

(3) failure to perform an imaging study of the head prior to discharging the pateint

(4) failure to evaluate a patient with headache or other cranial complaint following head injury


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