Head Injury

Question 1

What is the lowest total GCS score?

Answer 1

3 - No response to E/V/M

Question 2

what is the highest total GCS score?

Answer 2

15

Question 3

GCS score parameters

Answer 3

Eye opening
Verbal response
Motor response

Question 4

Highest score for each GCS parameters

Answer 4

E - 4
V - 5
M - 6

Question 5

Head Injury GCS categorisation

Answer 5

Mild - GCS 14-15
Moderate - GCS 9-13
Severe - GCS 3-8

Question 6

Head Injury Sx

Answer 6

1. Pain in the head or neck
2. Loss of consciousness or drowsiness
3. Confusion or amnesia (memory loss)
4. Seizures
5. Vomiting
6. Changes to vision or hearing
7. Neurological Sx: weakness, sensory changes, ataxia or difficulty speaking

Question 7

Head Injury clinical presentations

Answer 7

External: Scalp lacerations or haematoma
Retinal haemorrhages/papilloedema
Unequal/Unresponsive pupils
Down/out gaze: CN III palsy

Question 8

Basal Skull Fracture presentation

Answer 8

• Periorbital haematomas
• Clear discharge from ear/nose (CSF leakage)
• Battle’s sign: mastoid bruise
• blood behind TM: Haemotypanum

Question 9

Cushing’s Traid

Raise ICP presentations

Answer 9

HTN, Bradycardia, SOB

Question 10

Airways Mx for GCS <8

Answer 10

Maintain Airways: Intubation/Ventilation

Question 11

Head Injury choice of imaging

Answer 11

non-contrast CT head

Question 12

Head Injury Acute Mx

Answer 12

1. IV flud: Hypotensiive
2. O2: for low O2 sat
3. Pain Mx: for Raised ICP
4. Tranexamic acid: for GCS <12
5. Reverse anticoagulation
6. Maintain normoglycaemia: insulin/dextrose

Question 13

GCS Eye opening scale

Answer 13

4 - Spontaneous
3 - Sound
2 - Pressure
1 - No response

Question 14

GCS Verbal response scale

Answer 14

5 - Orientated
4 - Confusion
3 - Words
2 - Sound
1 - non verbal

Question 15

GCS Motor scale

Answer 15

6 - Obeys commands
5 - Moves to localised pain
4 - Flex to withdraw from pain
3 - Abnormal flexion
2 - abnormal extension
1 - No response

Question 16

1h CT head scan criteria for Head Injury

Answer 16

1. GCS <12 on initial assesment
2. GCS <15, 2h after injury
3. > 1 vomiting
4. Post-traumatic seizure
5. Focal neurology deficit
6. Open/Depressed fracture
7. Signs of basal skull fracture

Question 17

8h CT head scan criteria for Head Injury

Answer 17

loss of consciousness or amnesia with
1. age 65 or over
2. any current bleeding or clotting disorders
3. dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of more than 1 m or 5 stairs)
4. more than 30 minutes’ retrograde amnesia of events immediately before the head injury.

Question 18

Raised ICP Mx in head injury

Answer 18

1. Pain analgesia
2. Mannitol or Hypertonic saline