Mind the GCS
A patient opens their eyes to voice, is confused, and obeys commands. What is the GCS?
13 (E3 V4 M 6)
This skull fracture may cause periorbital ecchymosis and CSF rhinorrhea.
Basilar skull fracture
This hemorrhage classically occurs between the skull and dura.
Epidural hematoma
A unilateral fixed, dilated pupil can be an early clue to this herniation syndrome.
Uncal herniation
This injury involves disruption of all motor and sensory function below the neurologic level of injury.
Complete Cord syndrome
When assessing GCS motor response, this finding earns 5 points.
Localizing stimulus (crossing midline and above the clavicle)
Battle sign is indicative of a fracture found in this location.
Middle Fossa fracture
This bleed commonly results from tearing of bridging veins.
Subdural hematoma
Downward displacement of the cerebellar tonsils through the foramen magnum describes this herniation.
Tonsillar herniation
Hypotension with bradycardia after cervical SCI suggests this type of shock.
Neurogenic shock
A patient opens eyes to pressure, makes incomprehensible sounds, and reaches for the yankuer during suctioning. What is the GCS?
9 (E2 V2 M5)
Clear drainage from the nose after head trauma raises concern for this complication. List 3 interventions.
CSF leak, Bed rest, head of bed flat, antibiotics
A brief loss of consciousness followed by a lucid interval and rapid deterioration is classically associated with this hemorrhage.
Epidural hematoma
A patient with a normal initial CT continues to have headache, dizziness, sleep disturbance and difficulty concentrating weeks after injury. What condition should be considered?
What is persistent post-concussive symptoms/post-concussion syndrome?
Sacral sparing strongly suggests this broad category of spinal cord injury.
Incomplete spinal cord injury
When assessing an intubated trauma patient, why can the total GCS be misleading?
Verbal score can be calculated since can't test verbal response
A patient with suspected basilar skull fracture requires gastric decompression. Which route should generally be avoided?
Nasal
CT shows hyperdensity within the subarachnoid space. Patient has a history of hyperlipidemia, diabetes mellitus, hypertension and falls in the past. Identify the hemorrhage.
SAH, spontaneous = bleed
A patient with a normal initial CT continues to have headache, dizziness, sleep disturbance and difficulty concentrating weeks after injury. What condition should be considered?
What is persistent post-concussive symptoms/post-concussion syndrome?
Priapism, flaccid paralysis, absent reflexes and loss of sensation immediately after SCI may indicate this phenomenon.
Spinal shock
A patient initially crosses midline and now the patient is flexing arms away from trunk to pressure. What is the motor score initially and now?
Neurological deterioration: M 5 now M 4 (from localizing to normal flexion)
A patient was a passenger in a car that was stopped on the road and were hit at 60 km/hr. The patient is intubated, cervical collar in place and spinal precautions maintained. Ct neck shows no acute fracture or dislocation. What are you anticipating with this patient?
Cervical collar remains in place, until mri can rule out ligamentous injury
A patient presents with sudden left-sided hemiplegia, left hemisensory loss, rightward gaze deviation, vomiting, and rapidly decreasing LOC. Non-contrast CT demonstrates a hyperdense collection within the right basal ganglia with surrounding edema and mass effect. What type of hemorrhage is occurring?
Intracerebral hemorrhage, non traumatic = stroke
A patient remains profoundly unconscious following a high-speed MVC despite CT findings that appear relatively unimpressive. What injury should be suspected?
What is diffuse axonal injury?
A patient has upper-extremity weakness greater than lower-extremity weakness after cervical hyperextension. Identify the syndrome.
Central cord syndrome