Chapter 6 - Head Trauma

Question 1

GCS score is used as an objective measure of the severity of brain injury

Using the GCS score - categorize the severity of injury

Answer 1

Mild - 13-15
Moderate - 9-12
Severe - 8 or less

Question 2

Clinical signs a base of skull injury

Answer 2

Periorbital ecchymosis - racoon eyes
Retroauricular ecchymosis - battle sign
CSF rhinorrhea or otorrhea
CN 7, 8 fallout

Question 3

Admission criteria for mild traumatic brain injury?

Answer 3

CT scan abnormal or no CT scan available
CSF leak
Skull fracture
Focal neurological deficit
GCS does not return to 15 within 2 hours
All penetrating head injuries
History of prolonged LOC
Moderate to severe headache
Significant associated injuries
No reliable companion at home

Question 4

Initial management of mild traumatic brain injury (GCS 13-15)

Answer 4

AMPLE history - particularly anticoagulation
Neurological examination
Determine MOI, time of injury, initial GCS, confusion, amnesia interval, seizure, headache severity

Secondary survey

Diagnostic
+/- CT scan
Blood/Urine ETOH and toxicology

Question 5

List the indications for CT brain in patients with mild traumatic brain injury

Answer 5

Canadian CT head rule

Witnessed LOC, definite amnesia or witnessed disorientation in a patient with a GCS of 13-15 and 1 or more of the following:

High risk of nuerosurgical intervention:

GCS of 15 or less after 2 hours
Suspected open or depressed skull fracture
Any sign of BOS fracture
Vomiting >2 episodes
Age > 65
Anticoagulation use*

Moderate risk for brain injury on CT:

LOC >5min
Retrograde amnesia >30min
Dangerous mechanism - PVA, FFH >1m or 5 stairs