TBI and Coma

Question 1

Glasgow Coma Scale (GCS)

Answer 1

CS 13-15: mild injury
GCS 9-12: moderate injury
GCS 8 or <: severe injury
Three sections: eye opening (spontaneous, to speech, to pain, none)
verbal (orientated, confused, inappropriate words, moans, none)
motor (follows commands, localizes to pain, withdraws to pain, abnormal flexion, abnormal extension, none)

Question 2

Indication for CT Scan in ER

Answer 2

GCS < 15 two hours after injury
Suspected open or depressed skull fracture
Any sign of basilar skull fracture***–CSF leak
Two or more episodes of vomiting
65 YO or older
Amnesia before impact of 30 or more minutes
Dangerous mechanism
Neurologic deficit
Seizure
Bleeding diathesis or on oral anticoagulants
Intoxication

Question 3

Postconcussion syndrome:

Answer 3

HA, dizziness, neuropsychiatric sx, & cognitive impairment

Question 4

Coma Definition

Answer 4

Unarousable unresponsiveness Lasting greater then 1 hour

Question 5

Coma Neurologic exam:

Answer 5

LOC: describe patient’s spontaneous behavior and responses to stimuli*
Arousability—shouting in the ear
Somatosensory stimuli—pressing the supraorbital nerve, angle of the jaw or squeezing the trapezius
Look in pupils!

Question 6

Decorticate posturing

Answer 6

UE abduction and flexion at the elbows, wrists, and fingers, together with lower-extremity extension, (includes extension and adduction at the hip, extension at the knee, and plantar flexion and inversion at the ankles.) BETTER PROGNOSIS…above red nucleus

Question 7

Decerebrate posturing

Answer 7

UE extension, adduction, and pronation together with LE extension…below red nucleus

Question 8

Respiratory patterns:

Answer 8

Cheyne-stokes: cyclic pattern hyperpnea & apnea
Hyperventilation
Apneustic breathing: prolonged pause end on inspiration
Ataxic breathing: irregular in rate and tidal volume