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Surgery Li 2 ZZZZ

This document summarizes key information about traumatic brain injury (TBI) assessment and management. It discusses the Glasgow Coma Scale for classifying TBI severity, important factors to gather from patient history and physical exam, and guidelines for determining when head CT imaging is needed. Signs of moderate to severe injury include abnormal pupil response and abnormal posturing, while mild injuries typically cause headaches, dizziness, and brief confusion. The New Orleans Criteria and Canadian CT Head Rule provide evidence-based guidance on deciding if CT is necessary.

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70 views17 pages

Surgery Li 2 ZZZZ

This document summarizes key information about traumatic brain injury (TBI) assessment and management. It discusses the Glasgow Coma Scale for classifying TBI severity, important factors to gather from patient history and physical exam, and guidelines for determining when head CT imaging is needed. Signs of moderate to severe injury include abnormal pupil response and abnormal posturing, while mild injuries typically cause headaches, dizziness, and brief confusion. The New Orleans Criteria and Canadian CT Head Rule provide evidence-based guidance on deciding if CT is necessary.

Uploaded by

Apmc Schwartz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Learning Issue Presentation

Prepared by: Chua, Catherine & Ali, Aliah


• TBI severity is classified using the GCS.

• The scale is composed of three components: eye


opening (1 to 4 points), verbal response (1 to 5 points),
and motor response (1 to 6 points).
Schwartz 10th ed. chap 42.
• The sum of these components defines the TBI severity
classification into severe (GCS score of 3 to 8),
moderate (GCS score of 9 to 13), and mild (GCS score
of 14 or 15).

• The motor score independently correlates with outcome,


almost as well as the full score.
• The results of history, examination, and diagnostic
imaging will allow the distinction into two categories of
injury: moderate-severe brain injury and mild brain injury.
HISTORY
• To gain important insight into the mechanism of injury and
overall severity of TBI (e.g., height of fall, impact
surface condition, damage sustained to vehicle,
airbag deployment, seat belt use, history of ejection
from the vehicle, or report of fatalities at the scene).

• Premorbid medical history, medications (especially


anticoagulants), drug use, and/or alcohol intoxication
are also important in the assessment and treatment of
acute TBI.
PHYSICAL EXAMINATION

• Obtain the GCS.


• Determine pupillary response.
• In an unresponsive patient, a single fixed and dilated
pupil may indicate an intracranial hematoma with uncal
herniation that requires rapid surgical decompression.
• Bilateral fixed and dilated pupils suggest increased ICP
with poor brain perfusion, bilateral uncal herniation, drug
effect (such as atropine), or severe hypoxia.
• Bilateral pinpoint pupils suggest either opiate exposure
or central pontine lesion.
• Decorticate posturing (upper extremity flexion and lower
extremity extension) indicates severe intracranial injury
above the level of the midbrain.
• Decerebrate posturing (arm extension and internal
rotation with wrist and finger flexion and internal rotation
and extension of the lower extremities) indicates a more
caudal injury.
IMAGING

• Individually assess each patient’s mechanism of injury,


history, comorbidities, and signs and symptoms when
determining the need for CT imaging of the head and
cervical spine.
Minor Injury
• Briefly lost consciousness or been stunned after a minor head injury
• Full alert ant attentive within minutes
• Headache
• Dizziness
• Faintness
• Nausea
• Single episode of emesis
• Difficulty of concentration
• Brief amnestic period
• Slight blurring of vision
Intermediate Severity Injury

• Not fully alert


• Persistent confusion
• Behavioral changes, worse at night
• Extreme dizziness
• Focal neurologic deficit
Severe Injury

• Comatose at the moment of injury

Indicators of poor prognosis:


• Older age
• Increased ICP
• Early hypoxia or hypotension
• Compression of brainstem
• Delay in evacuation of large ICH
DECISION RULES FOR HEAD CT IMAGING IN
ADULTS

• The two most commonly used evidence-based clinical


decision rules for head CT in adults are the New Orleans
Criteria and the Canadian CT Head Rule.
• References: Tintinallis Emergency Medicine 8th ed
• Schwartz Principles of Surgery 10th ed

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