Concussion/TBI Flashcards
Canadian CT Head Rule
Definition of Minor Head Injury
Minor head injury is defined as witnessed loss of consciousness, definite amnesia, or witness disorientation in patients with a GSC 13-15
Canadian CT Head Rule
High Risk - for Neurological intervention
1 of the follow:
1) Suspected open or depressed skull fracture
2) Vomiting more than 2 episodes
3) GCS of less than 15 at 2 hours
4) Signs of basilar skull fx (raccoon eyes, CSF leakage)
5) Age 65 or older
Canadian CT Head Rule
Medium Risk for brain injury on CT
1 of the following:
1) Amensia greater than 30 minutes prior to injury
2) Severe mechanism: hit by a MVA, fall from greater than 3 feet, ejected from a MVA
PECARN
CT recommendation for younger than 2 years old
1) GCS less than 15 OR
2) AMS OR
3) Palpable Skull fx
PECARN
CT recommendation for 2 years old or older
1)GCS less than 15 OR
2) AMS OR
3) Basilar skull fx
PECRAN
Observation vs CT head for younger than 2 years old
1) Not acting normal
2) LOC greater than 5 seconds
3) Non-frontal Hematoma
4) Severe mechanism
PECRAN
Observation vs CT head for 2 years or older
1) Hx of LOC
2) Hx of vomiting
3) Severe mechanism
4) Severe headache
Canadian C-Spine Rule
High Risk Factors which mandates immobilization
YES==> ?
NO==> ?
- 65 year or older
- Severe mechanism
- Numbness or tingling in extermities
Yes ==> immobilization
No ==> Low risk factors?
Canadian C-Spine Rule
Low risk factors which allow safe assessment of ROM
Yes ==> ?
No ==>?
- Simple rearend MVC
- No neck pain at scene when asked
- No neck pain with C-spine palpation
- Ambulatory at any time at scene
Yes==> can the patient able to actively rotate head 45 degrees?
No==> immobilization
Stage 1: Return to play
Symptom limited - activity
Daily activates do not provoke symptoms
Return to play
Stage 2
Light aerobic activities
Walking/stationary cycling at slow to medium pace - no resistance training
Return to play
Stage 3
Sport specific activities
Running or skating drills - no head impact activities
Return to play
Stage 4
Noncontact training drills
Harder training drills, passing drills
May start progressive resistive training
Return to play
Stage 5
Full contact practice
medical clearance
participate in normal training activities
Glasgow Coma Scale
Eye Opening Response
4 - Spontaneous
3 - To speech
2 - To touch
1- NR
Glasgow Coma Scale
Verbal Response
5 - Alert and orientated
4 - Confused
3 - Inappropriate words
2 - Incomprehensible sounds
1 - NR
Glasgow Coma Scale
Motor Response
6 - Follow commands
5 - Localize to pain
4 - Flexion withdraw
3 - Abnormal flexion: Decorticate
2 - Abnormal extension: decerebrate
1 - No response
Ranchos Los Amigos Scale
Level 1
No response to external cues
Ranchos Los Amigos
Level 2
Generalized Response: non-specific, inconsistent and non-purposeful
Ranchos Los Amigos
Level 3
Localized Response: Inconsistent with delay, follows simple commands
Ranchos Los Amigos
Level 4
Confused and agitated
Ranchos Los Amigos
Level 5
Confused and inappropriate, non-agitated
Ranchos Los Amigos
Level 6
Confused and appropriate response
Ranchos Los Amigos
Level 7
Appropriate and Autonomic (Robotic)
Ranchos Los Amigos
Level 8
Purposeful, appropriate response; Stand by assistance
Ranchos Los Amigos
Level 9
Purposeful, appropriate response; stand by assistance on request
Ranch Los Amigos Level 10
Purposeful, appropriate response; modified independent
TBI Severity
LOC
Mild: Less than 30 minutes
Moderate: 30 minutes - 24 hours
Severe: More than 24 hours
TBI Severity
Alteration of consciousness
Mild: a moment to 24 hours
Moderate: Greater than 24 hours
Severe: Greater than 24 hours
TBI Severeity
Post traumatic amnesia
Mild: 0 to 1 day
Moderate: Between 1-7 days
Severe: 7 days
Highly Recommended measures for TBI patients
Outpatient only
HiMat
Highly Recommended for TBI patients
Inpatient only
Coma Recovery Scale- Revised
Moss Attention Rating Scale
What are the 6 sub scales of the Coma Recovery Scale?
1) Motor
2) Auditory
3) Visual
4) Oromotor
5) Communication
6) Arousal function
What are the cut off scores for the Agitated Behavioral Scale?
WFL: Less than 20
Mild: 22-28
Moderate: 29-35
Severe: Greater than 35
What are the MCID/MCD for the Disorders of Consciousness Scale
MDC for BI = 5.6
MCID for BI = 8.6
What is the MDC for Community Balance and Mobility Scale in TBI patients
BI MDC: 9.6 or 7.5 points
