MINOR TRAUMATIC BRAIN INJURY

Question 1

Initial Management

Answer 1

Determine mechanism, time of injury, initial GCS, confusion, amnesia, amnestic interval, seizure, headache severity etc.

Anticoagulant Use

AMPLE hx

Secondary survey includes focused neurological exam

Question 2

Diagnostics

Answer 2

CT Scanning as determine by head CT rules

Blood/Urine EtOH and toxicology screens

Question 3

Secondary Management

Answer 3

Serial neuro examinations until GCS is 15 and patient has no preservation or memory deficits

Rule out indication for CT

Question 4

Disposition

Answer 4

Home if patient does NOT meet the criteria for admission

Discharge with head injury warning sheet and follow up arranged

Question 5

Indications for Admission

Answer 5

Focal neurological deficit

Vomiting (> two episodes)

Age > 65

GCS does not return to I5 within 2 hours

No CT available

CT abnormal, skull fracture, CSF leak,

Significant intoxication (admit or observe)

Question 6

Management if Admission

Answer 6

Perform serial neurological examinations

Perform follow up CT if first is abnormal or GCS remains less than 15

Repeat CT (or transfer) if neurological status deteriorates and neurosurgical evaluation

Question 7

Indications for CT Head (in patients with mild TBI): High Risk for Neurosurgical Intervention

Answer 7

GCS 13-15 and at least >/1: witnessed LOC, definite amnesia, witnessed disorientation
AND ANY ONE OF THE FOLLOWING:
GCS <15 at 2 hours post injury
Suspected open or depressed skull fracture
Any sign of basilar skull fracture (hemotyopanum, raccoon eyes, battle’s sign, CSF oto-/rhinorrhea
*Anticoagulation
>/2 episodes of vomiting
Age >/ 65 yrs

Question 8

Indications for CT Head (in patients with mild TBI): Medium Risk for Neurosurgical Intervention

Answer 8

LOC >/ 5 min

Retrograde Amnesia to the event >/ 30 min

Dangerous Mechanism: pedestrian struck by motor vehicle, occupant ejected from motor vehicle, fall from height more than 3 feet or 5 stairs