Exam 3 - TBI

Question 1

What GCS correlates to a mild, moderate, and severe TBI?

Answer 1

Mild: 13-15
Moderate: 9-12
Severe: 3-8

Question 2

What is a typical presentation of an acute mild TBI or “concussion”?

Answer 2

Confusion, amnesia, +/- LOC

Question 3

What are some concerning features of a mild TBI presentation?

Answer 3

• Clinical deterioration over time
• Precipitating symptoms
• Cushing reflex (triad of HTN, bradycardia, irregular breathing)

Question 4

What are some concerning exam findings that may indicate a basilar skull fracture?

Answer 4

• Hematympanum
• Battle sign (bruising behind ear)
• Raccoon eyes (periorbital ecchymosis)

Question 5

What is the SCAT5 and when is it typically used?

Answer 5

Sport Concussion Assessment Tool

Used frequently as sideline evaluation tool, initial office and follow-up assessment

Question 6

What is the diagnostic test of choice IF you obtain one on a patient with a mTBI?

Answer 6

Head CT w/o contrast

Question 7

What are some criteria to ordering a head CT in adults with mTBI?

Answer 7

• GCS < 15
• Any sign of basilar skull fracture
• Suspected open or depressed skull fracture
• 2 or more episodes of vomiting
• New neuro deficits
• On anticoagulant
• 60 years or older
• Seizure
• Anmesia > 30 mins prior to event
• Dangerous mechanism
• Intoxication, abnormal behavior

Question 8

In a moderate or severe TBI, what medication may be given as a neurosurgical intervention?

Answer 8

Tranexamic acid given within 3 hours of injury

Question 9

What are some admission criteria for a mTBI?

Answer 9

• GCS < 15
• Abnormalities on head CT
• Seizures
• Hx of underlying bleeding diathesis or on anticoagulants
• Recurrent vomiting
• Other neuro deficits

Question 10

What is included in the management of a mTBI?

Answer 10

• Cognitive rest for 24-48 hours
• No return to sport until able to fully return to school
• May need to be gradual return

Question 11

What are two big symptoms are associated with the presentation of Post-Concussion Syndrome?

Answer 11

• Headaches

- Dizziness

Question 12

What is the management of Post-Concussion Syndrome?

Answer 12

• Cognitive and physical rest
• Brain MRI w/o contrast if worsening symptoms
• Referral as needed

Question 13

What is Second Impact Syndrome?

Answer 13

Second trauma occurs prior to resolution of TBI symptoms causing rapid, diffuse, cerebral edema with increased IOP