Traumatic scenario management Flashcards
Glasgow coma scale categories
Categorises traumatic brain injury into:
Mild 13 - 15
Moderate 9 - 12
Severe 8 or less
Brain Trauma Guidelines for ICP monitoring
GCS 8 or less AND abnormal CT head is indication for ICP monitoring
Uses of GCS
Grading severity of traumatic brain injury
Used as indication for ICP monitoring (8 or less)
Used as indication for intubation
Used in APACHE II score
Used for determining the need for CT head in TBI by validated tools such as the Canadian CT Head Rule
E in GCS
Eye response (E)
1 = No eye opening
2 = Eye opening in response to pain stimulus (a peripheral pain stimulus, such as squeezing the lunula area of the patient’s fingernail is more effective than a central stimulus such as a trapezius squeeze, due to a grimacing effect)
3 = Eye opening to speech (not to be confused with the awakening of a sleeping person; such patients receive a score of 4, not 3)
4 = Eyes opening spontaneously
V in GCS
Verbal response (V)
1 = No verbal response
2 = Incomprehensible sounds (moaning but no words)
3 = Inappropriate words (random or exclamatory articulated speech, but no conversational exchange)
4 = Confused (the patient responds to questions coherently but there is some disorientation and confusion)
5 = Oriented (patient responds coherently and appropriately to questions such as the patient’s name and age, where they are and why, the year, month)
M in GCS
Motor response (M)
1 = No motor response
2 = Extension to pain (extensor posturing: abduction of arm, external rotation of shoulder, supination of forearm, extension of wrist, decerebrate response)
3 = Abnormal flexion to pain (flexor posturing: adduction of arm, internal rotation of shoulder, pronation of forearm, flexion of wrist, decorticate response)
4 = Flexion/Withdrawal to pain (flexion of elbow, supination of forearm, flexion of wrist when supra-orbital pressure applied ; pulls part of body away when nailbed pinched)
5 = Localizes to pain (Purposeful movements towards painful stimuli; e.g., hand crosses mid-line and gets above clavicle when supra-orbital pressure applied)
6 = Obeys commands (the patient does simple things as asked, e.g. stick out tongue or move toes)
GCS of 8 or less
Indication for definitive airway
Indication for ICP monitoring in presence of abnormal CT scan
Define definitive airway
A definitive airway is one in which an inflated cuff sites below the vocal cords
Guidelines for CT in head injury
NICE guidelines 2014
Indications within the hour
Indications for <8 hours
Indications for CT head within 1 hour
GCS of less than 13 on assessment in ED
GCS of less than 15 at 2 hours after the injury
Suspected open or depressed skull fracture
Any signs of base of skull fracture
Post-traumatic seizure
Focal neurological deficit
> 1 episode of vomiting
Indications for CT head within 1 hours
Age >65
History of bleeding or clotting disorders
Dangerous mechanism: RTA, height greater than 1 metre/ 5 stairs
> 30 minutes of retrograde amnesia from before head injury
Sources of bleeding
On the floor and 4 more
- Thorax
- Abdomen
- Pelvis
- Long-bones
- Peripherally
Indications for urethrogram
Displaced pelvic fractures
Gross haematuria
Blood at meatus, perianal/scrotal haematoma, high-riding prostate
Skeletal injuries associated with genitourinary injury:
Pelvic fractures
— posterior urethrethal injury (above the urogenital diaphragm) and bladder injury
Perineal straddle injury
— anterior urethral injury
Fracture of the lower posterior ribs, lower thoracic or lumbar vertebrae
— renal or ureteral injuries
Trauma + LUQ pain
Perforated viscus
Splenic injury / rupture
Left kidney injury
Pancreatic injury: tail
Diaphragmatic injury
