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Traumatic Brain Injury Case Studies

Traumatic Brain Injury Case Studies. Case Study #1. 16 year old male, jumping from bridge, slipped and struck head on railing before hitting the water. Came up above water, but appears dazed and slow to respond to questions. His mother brings him to the local emergency department.

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Traumatic Brain Injury Case Studies

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  1. Traumatic Brain InjuryCase Studies

  2. Case Study #1

  3. 16 year old male, jumping from bridge, slipped and struck head on railing before hitting the water. Came up above water, but appears dazed and slow to respond to questions. His mother brings him to the local emergency department.

  4. On your initial assessment, he is amnestic to the events surrounding his injury, oriented to person, place and time, and is complaining that “the back of my head hurts”. The rest of his exam is unremarkable.

  5. Does this patient require a head CT? • Yes • No

  6. This Head CT Shows: 1. Epidural Hematoma 2. Subdural Hematoma 3. Subarachnoid Hemorrhage 4. Shear injury 5. No acute injury

  7. Based on his physical exam, mental status and head CT results, he should: • Have another CT scan in 6 hours • Be discharged to home with his mother • Be admitted to the Trauma Service for at least 24 hours • Spend the night in the Emergency Department

  8. As you are preparing his discharge paperwork, he says, “GOOD! I have football practice tomorrow!” Can he play? • Yes • No

  9. When can he return to football? A. When he says he feels fine B. When his mother thinks he is well enough to play C. After further evaluation demonstrates that he is no longer suffering from post concussive symptoms.

  10. Case Study #2 75 year old woman, tripped over dog, striking head on floor. She sustained a brief + loss of consciousness, prior to waking up with her daughter at her side.

  11. Daughter transports her to local Emergency Department. She is awake and alert, and complains of “the worst headache of my life” She is evaluated by the ED staff, who call you once they see her head CT

  12. This Head CT shows: A. Epidural Hematoma B. Subdural Hemorrhage C. Subarachnoid Hemorrhage D. SAH & EDH E. SDH & EDH F. No acute injury

  13. Epidural Hematomas are often associated with • Cervical spine fractures • Parietal skull fractures C. “the worst headache of my life” D. Venous bleeding

  14. Subarachnoid hemorrhages frequently A. Require surgical evacuation B. Produce “the worse headache of my life” C. Produce significant “mass effect” D. A & C E. All of the above F. None of the above

  15. She is admitted to the trauma service, hemodynamically stable and in no acute distress.Your two main goals of care in the immediate future? • Get her a diet and a blanket • Consult PT and OT • Prevent hypoxia and hypovolemia • Contact case management and arrange for transfer to skilled nursing facility

  16. Does she require a repeat Head CT? • Yes • No

  17. Case Study #3 22 year old man s/p single vehicle MVC vs. tree. EMS finds him unresponsive (GCS 3). He is intubated without drugs, IV access is initiated and he is transported to the ED for evaluation. Trauma evaluation notes a right forearm deformity, and scattered abrasions. Prior to admission to the Trauma Service, he is taken through the CT scanner:

  18. This Head CT shows: • Epidural Hematoma • Subdural Hematoma • Subarachnoid Hemorrhage • Shear injury 5.No acute injury

  19. Your two main goals during his resuscitation are to prevent ________ and ________. • Pressure ulcers, contractures • Family arguments, disagreements • Hypoxia, hypovolemia • Pain, discomfort

  20. He has an ICP monitor placed, with ICP’s ranging 8-10. He remains hemodynamically stable, and is cleared to have his forearm repaired by the Orthopaedic service. On Hospital Day #4, he is trached and PEG’d, and weaned from the ventilator by hospital day #5. His ICP monitor is discontinued.

  21. His family asks you, “When will he wake up?” • He may never wake up • The longer he remains comatose, the less likely it is for him to wake up • If he wakes up, he will likely emerge through several phases of the RLA scoring system. • It will take up to a year to determine his long term, “new normal”, baseline. • All of the above • None of the above

  22. Speech Therapy is consulted for a cognitive evaluation. They report that he is functioning at a RLA II level. You can expect him to have: • No response • Confusion with agitation • Generalized responses • Confusion without agitation • Appropriate responses

  23. He progresses to a RLA III (localized response) emerging IV (confused, agitated). PT and OT come to evaluate him.You anticipate they will recommend • Skilled Nursing Facility • Inpatient Rehabilitation • Home with Family • LTAC

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